Lymphocyte-infiltrated FIGO Stage IIB squamous cell carcinoma of the cervix is a prominent factor for disease-free survival

BACKGROUND

The data of histopathological factors affecting prognosis of patients with FIGO Stage IIB squamous cell carcinomas of the cervix are rarely known. The purpose of this study was to evaluate the histopathological factors rendering therapeutic failure in patients with FIGO Stage IIB.

METHODS

Survival and prognostic factors were analyzed in 83 patients with FIGO stage IIB squamous cell carcinoma of the cervix treated with radical hysterectomy and retroperitoneal lymphadenectomy between 1980 and 1989. The relapse-free and overall survival rate was 61.4%.

RESULTS

Univariate analysis demonstrated that the degree of lymphoreticular cells infiltrating the cervix, lymph node metastases, barrel shape of the cervix, lymph-vascular space invasion, more than three lymph nodes involved, and bulky tumor size (i.e. tumor size larger than 4 cm) were of prognostic significance in disease-free survival. However, pronounced lymphoreticular cells infiltrating the cervical cancer was the only independent factor to disease-free survival in patients with FIGO stage IIB squamous cell carcinoma treated with radical hysterectomy and retroperitoneal lymph node dissection using multivariate analysis.

CONCLUSIONS

We concluded that the immune function of the host might play a crucial role in the process of anti-neoplasm even if local advanced carcinoma of the cervix is noted. Individual therapies may very well have limited efficacy based on the patient's tumor or the inherent host response. How to strengthen the power of the host's immune system may offer another thinking process to treat such a subgroup of patients. More studies are required.

Allele distribution at the FMR1 locus in the general Chinese population

Fragile X syndrome is an important disease of hereditary mental retardation. Its prevalence in the Chinese population is not clear. We amplified FMR1 CGG repeats from male newborns' blood spots. Approximately 45% of the males had 28 CGG repeats and another 19% had 29 repeats. Besides this major peak, there was a second peak at 34 and 35 repeats. From the 1000 males studied, 3 were found to have repeat numbers in the high borderline range (each with 50, 52 and 53 repeats). This result provides a low but significant risk of fragile X syndrome in the Chinese population.

Factors correlated with number of metastatic lymph nodes in gastric cancer

OBJECTIVE

We had previously reported a reasonable categorization of the number of positive lymph nodes (LN: 0, 1-4, 5-8, and > 8) as a prognostic indicator. This study was an extension, to see which factors correlated with number of positive lymph nodes.

METHODS

A total of 533 patients with gastric adenocarcinoma, who underwent curative surgery between January 1988 and December 1995, were entered into this study. Patients were divided into four groups according to metastatic LN number (0, 1-4, 5-8, and > 8). Their survival and clinicopathological factors were analyzed.

RESULTS

A total of 16,457 LNs, with an average of 30.9 per specimen, were removed, of which 1686 (10.2%) showed metastases. The 5-yr cumulative survival rate decreased as the number of metastatic LNs increased, ie., 91.3% for LN 0; 67.4% for LN 1-4; 37.2 for LN 5-8, and 14.1% for LN > 8. Multivariate analyses showed that depth of cancer invasion (odds ratio: 2.4), gross appearance (odds ratio: 1.9), size (odds ratio: 1.9), and location (odds ratio: 1.4) of tumor were four independent factors correlated with the number of metastatic LNs. Number of metastatic LNs increased with advanced Japanese nodal stage and UICC-TNM stage.

CONCLUSIONS

Depth of tumor invasion, and gross appearance, size, and location of tumor were four pathological factors independently correlated with number of metastatic LNs in gastric cancer.

Retrobulbar haemodynamic changes studied by colour Doppler imaging in glaucoma

PURPOSE

To determine the effect of spontaneously elevated intraocular pressure (IOP) on the ocular circulation, and evaluate the result of IOP-lowering procedures in terms of haemodynamics.

METHODS

Colour Doppler imaging (CDI) was employed to determine the peak systolic velocity (PSV), end-diastolic velocity (EDV) and time average maximal velocity (TAMV), as well as the Pourcelot ratio (PR) and pulsatility index (PI), of the central retinal artery (CRA), posterior ciliary arteries (PCA) and ophthalmic artery. Various CDI parameters of the eyes with elevated IOP were compared with those of the clinically healthy fellow eyes and the control eyes, separately. Also, data from CDI of glaucoma eyes obtained during the period of elevated IOP and then following IOP-lowering procedures were compared, deliberately avoiding the influence of glaucoma medications.

RESULTS

Eyes (n = 12) with elevated IOP showed significantly decreased flow velocities of the CRA and significantly increased PR and PI of the nasal and temporal PCA, compared with the fellow and control eyes, respectively. Following IOP-lowering procedures, the PR and PI of the nasal PCA decreased significantly.

CONCLUSION

Spontaneously elevated IOP may induce haemodynamic changes in the CRA and PCA, but no significant change is identified in the ophthalmic artery. Flow velocities tend to decrease while the resistance indices tend to increase with elevated IOP. Such haemodynamic changes may reverse following normalisation of IOP.

Mucopolysaccharidosis type II (Hunter's syndrome) in Taiwan

The mucopolysaccharidoses are a group of inherited disorders of lysosomal storage of glycosaminoglycans. Among them, mucopolysaccharidosis (MPS) type II (Hunter's syndrome), caused by a deficiency in iduronate sulfatase, is the only one inherited in an X-linked recessive manner. We describe 12 Hunter's syndrome patients and seven carriers, with precise analysis of glycosaminoglycan content in urine and iduronate sulfatase activity in cultured fibroblasts and plasma. Their ages at the time of diagnosis ranged from 1 year 10 months to 11 years (mean 4.3 yr). The delay in diagnosis was from 1 month to 5 years (mean 2.1 yr) after the initial presentation. The most frequent initial complaints of the patients were delayed developmental milestones (75%) and speech (67%), although all patients were found to have coarsening of facial features at diagnosis. The difficulties in disease recognition allowed disease recurrence in four of the 11 families. Prompt clinical suspicion and referral will be important in genetic counseling for MPS type II and its management, if definitive therapy becomes available.

Ankle arthrography and chronic lateral ankle instability

Sixty-five ankle arthrograms of the patients who underwent surgical reconstruction for their chronic ankle instability from 1987 to 1995 were studied retrospectively by comparing their operative findings. There were 15 cases (23.1%) with definite positive arthrographic findings. In the remaining 50 cases (76.9%), the arthrograms showed a "tear-drop" extravasation of dye beneath the fibular tip which we called "suspectable positive". Of these all but one, which had normal ligament, proved to correspond to the operative finding. As there was only one false positive finding among our surgical cases with both the "definite" and "suspectable" positive arthrograms, we concluded that ankle arthrography is relatively reliable and may be worth doing even in chronic cases if only for reference. Even when other diagnostic methods are negative, arthrography might help surgeons make surgical decisions in clinical symptomatic cases.

Phosphorylation of the N-formyl peptide receptor is required for receptor internalization but not chemotaxis

The human N-formyl peptide receptor (FPR) is a member of the family of leukocyte, G protein-coupled, chemoattractant receptors. To determine the role(s) of receptor phosphorylation in FPR processing and formylmethionylleucylphenylalanine (fMLF)-mediated chemotaxis, we utilized U937 cells expressing the recombinant wild type receptor and a mutant form of the FPR. This mutant, which lacks all of the serine and threonine residues in the C terminus of the receptor, DeltaST, has recently been shown to produce a receptor capable of fMLF binding and G protein activation but was demonstrated not to undergo fMLF-dependent phosphorylation or desensitization of the calcium mobilization response upon repeated exposure to agonist (Prossnitz, E. R. (1997) J. Biol. Chem. 272, 15213-15219). In this report, we examined the role of receptor phosphorylation in FPR internalization and leukocyte chemotaxis. Whereas the wild type receptor was rapidly internalized upon stimulation, the phosphorylation-deficient mutant was not, remaining entirely on the cell surface. In addition, contrary to the hypothesis that receptor processing and recycling are required for chemotaxis, we found no defect in the ability of the mutant FPR to migrate up a concentration gradient of fMLF. These results indicate that phosphorylation of the FPR is a necessary step in receptor internalization but that receptor phosphorylation, desensitization, and internalization are not required for chemotaxis.

Separation of porphyrins by capillary electrophoresis in fused-silica and ethylene vinyl acetate copolymer capillaries with visible absorbance detection

A mixture of 5 porphyrins were separated by capillary electrophoresis. A UV-VIS detector was used to detect the separated components. Separation was performed in 2 types of capillaries, i.e. fused-silica and ethylene vinyl acetate copolymer (EVA) plastic capillaries. The concentration limit of detection (CLOD), mass limit of detection (MLOD), and relative standard deviations (RSD) of migration time and area were investigated. LOD was comparable to that of epi-fluorescence detection. LOD was lower when separation was performed in EVA capillary compared to fused-silica capillary. RSD of migration times of the porphyrins when separated in fused-silica capillary ranges between 0.5 to 1.6% and in EVA capillary ranges between 0.3 to 1.2%. Area RSD in fused-silica capillary ranges between 7 to 20% and in EVA capillary ranges between 4.7 to 12.3%. Urine spiked with porphyrins was also analysed by CE using fused-silica and EVA capillaries. Analysis of urine sample spiked with porphyrins showed that stacking effect of porphyrins was observable only in fused-silica and not in EVA capillary. This led to similar LOD in fused-silica capillary to those for EVA capillary.

Salvage operation for neglected ankle fractures

From 1986 to 1993, 49 cases of untreated or poorly treated ankle fractures who received salvage surgery were followed up for an average of 36.4 months. The patients included 31 males & 18 females with an average age of 41.6y/o and the time interval from initial injury to reconstructive surgery average due 17.6 months. They were classified and treated according to their grade of reduction and degree of arthrosis. The surgical methods included arthrotomy & joint debridement, revised open reduction, lower tibial osteotomy and ankle arthrodesis, depending on different individual conditions. After surgery, all cases had symptomatic relief and functional improvement with an average score increased from 26.3 preoperatively to 86.8 at follow up. The goals of ankle fractures is as articular fractures, they are treated by surgical anatomic reduction with rigid fixation as early as possible in order to provide good functional results. Nevertheless they are varied in neglected ankle fractures according to their individual conditions: open reductions were performed on cases with no or little arthritic change even though arthrosis might occur later because, if necessary, future conversion to osteotomy or arthrodesis would be easier. As for late cases with advanced arthritis, ankle arthrodesis were done by compressive arthrodesis with necessary bone graft to secure fusion in an optimal position.

Intraoperative monitoring of skin temperature changes of hands before, during, and after endoscopic thoracic sympathectomy: using infrared thermograph and thermometer for measurement

OBJECTIVE

To investigate the roles of the second and third thoracic spinal segments in the preganglionic sympathetic innervation of the hand, and to compare skin temperature changes between thenar and other parts of palm before, during, and after endoscopic thoracic sympathectomy.

DESIGN

Twelve patients, four women and eight men, with severe palmar hyperhydrosis underwent endoscopic thoracic sympathectomy. The T3 segment was identified and dissected first, followed by T2 segment extirpation. Skin temperature changes of the hand were assessed by thermograph and thermometer simultaneously before, during, and after sympathectomy. Sympathetic skin responses were undertaken 1 day preoperatively and followed up 6 months postoperatively.

SETTING

An electrophysiological laboratory and operating room in a national medical center.

SUBJECTS

Twelve patients who sustained a profound degree of palmar hyperhydrosis.

INTERVENTIONS

Skin temperature differences of the hands were measured by infrared thermograph and thermometer before, during, and after endoscopic thoracic sympathectomy.

MAIN OUTCOME MEASURES

Group's average temperature differences, and sympathetic skin response (all or none response).

RESULTS

The T2 spinal segment is thought to be the main source of sympathetic outflow to the sweat glands of the hand. The group's average temperature changes were significantly higher at the 2nd through 5th fingers' tips than at the thenar after completion of T2 extirpation (p < .005).

CONCLUSIONS

Intraoperative monitoring of palmar skin temperature, as judiciously measured by infrared thermograph, yields useful information about the locations of the sympathetic segments and confirmation of their entire ablation by endoscopic thoracic sympathectomy.

The relationship of aging to endotoxin shock and to production of TNF-alpha

BACKGROUND

Aged people are considered prone to gram-negative bacteremia and septic shock. This relationship was tested in murine endotoxin shock.

METHODS

Balb/c mice of various ages (1.4-13.4 months) were intraperitoneally injected with lipopolysaccharide (LPS), and rates of survival were observed. The production of TNF-alpha in vivo induced by LPS was measured.

RESULTS

The survival rates were the smallest in the oldest and youngest groups. Production of TNF-alpha attained a maximum at 2 h after LPS injection and was smaller in the oldest group; it had a reciprocal relationship to survival rates in each group except the youngest group.

CONCLUSION

Old and young mice had smaller rates of survival and greater production of TNF-alpha following endotoxin shock induced by LPS.

The variation of cell type distribution in lung cancer: a study of 10,910 cases at a medical center in Taiwan between 1970 and 1993

The rise in the incidence of lung cancer has been associated with shifts in histologic distribution. A study was conducted to investigate changes in the cell type distribution in lung cancer in relation to age, sex, and smoking history, based on a retrospective analysis of 10,910 proven cases of lung cancer at the Veterans General Hospital-Taipei during the period from 1970 to 1993. The diagnosis in each case was substantiated by histologic samples from the original tumor site in the lung. Detailed smoking histories were obtained by personal interview at the time of the first admission. Adenocarcinoma (38.3%) was the most common type of lung cancer, followed by squamous cell carcinoma (37.1%) and small cell carcinoma (12.2%). Over the study period, the incidence of squamous cell carcinoma decreased from 46.4% to 36.2% in men (P < 0.005), adenocarcinoma increased from 30% to 36% in men (P = 0.001) and 50.7% to 64.8% in women (P = 0.008), and small cell carcinoma increased from 7% to 14% in men but showed no significant change in women. Adenocarcinoma exhibited a marked increase in both men and women, and surpassed squamous cell carcinoma as the most frequent type of lung cancer. Lung cancer among younger men, and among non-smoking older men and women, was more often adenocarcinoma. Small cell carcinoma showed a significant increase among males, differing from the trend for squamous cell carcinoma in men, though both are strongly associated with smoking. These findings suggest factors other then cigarette smoking could influence the development and distribution of lung cancer.

Hospital antibiotic prescribing successfully modified by 'immediate concurrent feedback'

1. To determine the effectiveness of ongoing immediate concurrent feedback (ICF) in minimizing 'inappropriate' sultamicillin or co-amoxiclav prescribing via the parenteral route (i.e. when the oral route was accessible and not contraindicated), a prospective controlled audit was carried out on hospital inpatients over a 20 month period. 2. After an education programme to promote oral rather than unnecessary intravenous (i.v.) use of sultamicillin, co-amoxiclav and certain other drugs, an ongoing ICF strategy was instituted. 3. ICF entailed issue of memos on the following day to prescribers of i.v. sultamicillin or co-amoxiclav for inpatients in whom this route was deemed 'inappropriate', by a specially trained nurse using strict objective criteria. The memos recommended oral prescribing (particularly of co-amoxiclav, currently the less expensive alternative). 4. After starting ICF, there were consistent, clinically and statistically significant reductions in the monthly proportions of (i) admissions prescribed i.v. sultamicillin or co-amoxiclav (38% P < 0.001), (ii) those in whom the route was 'inappropriate' (75%, P < 0.001), and (iii) corresponding ratios of i.v./oral usage and expenditure, oral sultamicillin/co-amoxiclav usage and expenditure, as well as total and per admission expenditure on i.v. forms (> or = 43%, P < 0.01). 5. For i.v. cefuroxime (for which there was no ICF) and its oral counterpart cefuroxime-axetil, there were no comparable changes in usage or expenditure. 6. This simple, ongoing ICF strategy was effective and well accepted; estimated net monthly savings being HK$26-30,000.

Identification of Leishmania species by a specific DNA probe that is conserved only in the maxicircle DNA of human-infective Leishmania parasites

An A + T-rich repeated DNA sequence cloned from maxicircle DNA of Leishmania mexicana amazonensis was found to be conserved in the maxicircles of human-infective Leishmania species but totally absent from non-human-infective ones. Differences in the pattern of distribution of this repeated sequence in the maxicircles of each human-infective Leishmania species potentially allow the development of a sensitive probe to differentiate among these species.

Predicting the probability of malignancy of the neck mass with logistic regression model: a statistical analysis of excisional biopsy of neck masses

One hundred and fifty-six patients with neck lesions were selected into this retrospective study between January, 1989 and December, 1990. All the patients visited OPD with the chief complaint of neck mass without other apparent symptoms and signs after initial work-up. They can be divided into 5 types according to the pathological reports: type a) metastatic lesion, type b) malignant lymphoma, type c) TB lymphadenitis, type d) miscellaneous benign lesion, and type e) inadequate specimen. They represent 24.4%, 12.8%, 9.6%, 52.6%, and 0.6% of the patients respectively. Type a) and type b) were classified as group of malignancy and the other three types were group of benignancy. Chi-square test and t-test were then used to evaluate the significant level of difference in each semiological factor between both groups. Several parameters were found to reach significant level, including tumor fixation, age of the patients, tenderness, location and size of the tumor, and history of cancer. Stepwise logistic regression was utilized to obtain a regression equation to predict the probability of malignancy in OPD patients with neck masses. The accuracy rate of prediction is 83.3%, if the cutpoint value is 0.5. A clinician can therefore avoid untimely excisional biopsy and delay in treatment planning.

Rapid detection of hog cholera virus in tissues by the polymerase chain reaction

A rapid method for the detection of hog cholera virus (HCV) in infected tissues, using polymerase chain reaction (PCR) was developed. Total RNA isolated from HCV-infected tissues was reverse transcribed with AMV reverse transcriptase and the resulting complementary DNA was amplified by Taq DNA polymerase in the presence of two HCV-specific primers. The amplified DNA fragment was detected by agarose gel electrophoresis. The sensitivity of this method was at 10(4) TCID50 of HCV. The sensitivity increased approximately 1000-fold when the DNA was reamplified with a set of nested primers. DNA sequencing analysis of the PCR products revealed that the HCV sequence amplified from a local field isolate was highly homologous to the HCV Alfort strain. This method may be useful for pathological and epidemiological studies of HCV in pigs.

Angular and rotational profile of the lower limb in 2,630 Chinese children

Angular and rotational profile of the lower limbs of 2,630 normal Chinese children from newborn to age 12 years were compiled using tibiofemoral angle, intercondylar, intermalleolar distance, medial and lateral rotation of the hip, and thigh-foot angle. Children with clinical tibiofemoral angles, intercondylar or intermalleolar distances tended to be bowlegged at birth, maximally knock-kneed at age 3 and to have normal lower limbs by age 8. Medial hip rotation increased steadily from birth to a maximum of 56 degrees at age 9, and lateral hip rotation decreased from birth to a minimum of 30 degrees at age 9. Significant differences between Chinese children and children of other races were highlighted.

Intravascular bronchioloalveolar tumour. A 20-year survival

An unusual case of intravascular bronchioloalveolar tumour in a 40-year-old Chinese woman is reported. The woman has survived 20 years after radiological abnormalities were first noted in her lungs. This slowly progressing endothelial lung tumour has only recently been recognized as a distinct pathological entity.

Primary hepatocellular carcinoma developing in a female patient on long term oral contraceptives--a case report

The association between hepatic tumours and oestrogen and progestogen therapy is well established. The risk of developing primary hepatocellular carcinoma (PHC) is small. In Africa and Asia where hepatitis B virus (HBV) infections are common, the development of PHC is also high. The presence of Hepatitis B core antibody indicates previous exposure to HBV and carries a risk of developing PHC by more than 34 times of non-infected normal. A Chinese female 29 years who had been on oral oestrogen and progestogen contraceptives continuously for 8 years developed PHC. She had no known illness due to HBV but was found to have concomitantly positive Hepatitis B core antibody in her sera. The presence of this HB core antibody and the long term consumption of oestrogen/progesterone derivatives may have been responsible for the early presentation of PHC in this patient. It is the first report in this country of PHC developing in a pill consumer since the introduction of oral contraceptives a decade ago In view of the prevalence of Hepatitis B in the region, this case finding warrants further study to determine whether (a) there is a higher frequency in pill consumers (b) an earlier age of presentation of hepatic malignancy. Meanwhile, it may be prudent to recommend alternative methods of birth control in individuals known to have been previously exposed to HBV infection, clinically or otherwise.

Respiratory obstruction due to relapsing polychondritis in a Chinese male

A case of relapsing polychondritis in a 30-year-old Chinese male is reported. The patient showed the following features: dyspnoea; hoarseness of voice; cauliflower deformity of the right ear; upper tracheal stenosis; swelling of the lower part of the sternum; pain in the costal cartilages. Airway obstruction as a presenting feature (as in this case) is unusual. The aetiology, clinical features and management of relapsing polychondritis are briefly discussed.