Hypospadias repair using a double onlay preputial flap

From an anatomical view, a more reasonable blood supply can be achieved in hypospadias repair using a double-faced onlay flap. A urethroplasty was performed in 15 patients with middle or posterior hypospadias using a double-faced onlay preputial flap (DOPF). In this method, the urethral plate is preserved and a double-faced preputial flap is developed. The inner face of the flap is sutured to the urethral plate to create the neourethra and the outer face together with the rest of the dorsal prepuce is used for ventral skin coverage. Postoperative complications occurred in 2 patients: 1 developed a fistula in the subcoronal region and 1 had dorsal skin necrosis and suture disruption of the glanular wings. The overall complication rate was 13%. The DOPF provides a well-vascularized ventral skin cover and reduces the area of avascular dorsal skin. The viability of the neourethra can be evaluated by simply looking at the outer face of the flap. However, the complication rate is similar to that of other techniques.

Self-focusing and frequency broadening of an intense short-pulse laser in plasmas

An intense ultrafast laser pulse propagating through a plasma undergoes self-focusing and self-phase-modulation as a result of relativistic mass nonlinearity. The inclusion of a quartic (r4) term in the expansion of the eikonal in the radial coordinate r allows the modification of the shape of the radial intensity profile. The front of the pulse, under the combined effects of time-dependent self-focusing and frequency downshifting, acquires a severely distorted temporal shape. The radial profile for I(lambda)2(mu) < 2.8 x 1018 W/cm2, where I is the axial laser intensity and lambda(mu), is the laser wavelength in micrometers, is transformed from a Gaussian to a super-Gaussian because of the faster convergence of the marginal rays than the paraxial rays. In the opposite case of I(lambda)(2)(mu) > 2.8 x 10(18) W/cm2 when nonlinear plasma permittivity approaches saturation, the radial profile in the axial region becomes broader than the Gaussian.

Diagnosis of Helicobacter pylori infection by stool antigen test in southern Taiwan

Helicobacter pylori (H. pylori) has been found to be associated with various gastrointestinal diseases. Confirmation of H. pylori infection includes invasive and non-invasive methods. There has been increasing interest in noninvasive tests recently. However, the geographical differences among H. pylori strains have been emphasized recently and the H. pylori strain in Taiwan showed a high cagA positive result and different vacA subtype when compared with those of Western countries. The aim of this study is to access and compare the reliability and the diagnostic accuracy of the stool H. pylori antigen tests by spectrophotometry and by the visual method, especially in Southern Taiwan. Thirty-two patients (18 men and 14 women; age range: 23-91 y/o, mean: 50.5 y/o) who underwent gastroendoscopy at Kaohsiung Medical University Hospital were enrolled in this study. H. pylori infection status was confirmed by culture or two positive test results on CLO test, histology and 13C-urea breath test (13C-UBT). The exclusion criteria included previous gastrointestinal tract surgery, use of antibiotics, proton pump inhibitor or compounds containing bismuth within 1 month of the study. Among them, 14 patients were with duodenal ulcer (DU), 4 with gastric ulcer (GU), 12 with non-ulcer dyspepsia, and 2 with GU and DU. Those patients had their stool collected for ELISA tests of H. pylori stool antigen (HpSA). The HpSA tests were positive in 16 of 18 patients diagnosed as H. pylori positive, and negative in 13 of 14 patients as H. pylori negative. The sensitivity and specificity were 88.9% and 92.9% respectively. The positive and negative predictive values were 94.1% and 86.7% respectively. The concordance of HpSA accessed by spectrophotometry and visual method is 100%, which makes this test even easier and cheaper. We concluded that stool HpSA test is a noninvasive, accurate, reliable, rapid and easy way to diagnose H. pylori infection in Southern Taiwan, either by spectrophotometry or by visual assessment.

Structure formation and tearing of an MeV cylindrical electron beam in a laser-produced plasma

The stability of a cylindrical, solid hot electron beam propagating in a high density plasma has been studied using a two-dimensional, hybrid Darwin code. The initially solid beam evolves into a hollow, annular beam due to the Weibel instability and generates strong magnetic fields on both sides of the annular ring. The annular structure subsequently breaks up into several beamlets via a mechanism similar to a tearing instability. It is found that the magnetic fields parallel to the direction of beam propagation also grow due to the tearing process.

Evaluation of an office-based urine test for detecting Helicobacter pylori: a Prospective Pilot Study

BACKGROUND/AIMS

To ascertain the reliability of a newly developed office-based urine test, the RAPIRUN test, used for detection of H. pylori infection.

METHODOLOGY

Urine specimens from 142 consecutive patients undergoing gastroendoscopy (77 men, 65 women; mean 52.0 years) were tested with RAPIRUN at the same time. The total reaction time for the urine test is 20 min. None of the patients had received any H. pylori eradicating treatment. The H. pylori status was evaluated based on 5 different tests: culture, histology, biopsy urease test, 13C-urea breath test, and the RAPIRUN test. A commercial office-based kit using an immunochromatographic technique was used to examine urine samples for H. pylori antibody. H. pylori status was defined as positive when the culture was positive or if 2 of the other 3 tests (histology, biopsy urease test, and 13C-urea breath test were positive.

RESULTS

Of 93 patients with H. pylori infection, 88 were tested as positive by RAPIRUN (sensitivity 94.6%). Of 48 patients without infection, 43 were found to be negative by RAPIRUN (specificity 89.6%). One case with an invalid urine test was excluded.

CONCLUSIONS

This urine test is a rapid, inexpensive, reliable and easy-to-use tool for the diagnosis of H. pylori infection in untreated patients. It can be used for mass screening of patients' H. pylori status, particularly in children, postgastrectomy patients, uncooperative patients, and patients undergoing bismuth or proton pump inhibitor treatment.

Multidimensional high performance liquid chromatography - capillary electrophoresis separation of a protein digest: An update

The trypsin digest of a mixture of two proteins, namely cytochrome c and myoglobin, was first separated in the first dimension by high-performance liquid chromatography (HPLC). Fractions from the HPLC were collected every 30s with the aid of a fraction collector into a 96-well microtiter plate. After concentration, all the collected fractions were analyzed simultaneaosly in the second dimension by a 96-array capillary electrophoresis system. The labeled peptides were detected by laser-induced fluorescence. An internal standard, allura red, was added to all the fractions, prior to capillary electrophoretic analysis. The internal standard serves two functions, migration time correction and signal intensity correction. The data are presented in two different formats, as an electropherogram of all the fractions and in a two-dimensional (2-D) format. The 2-D plot of the data shows the density of each spot, which corresponds to the concentration of the migrating peptides. The total experimental time for the HPLC and capillary electrophoretic analyses ist less than 1 h, which ist much faster than using 2-D slab-gel electrophoresis or single-capillary capillary electrophoresis.

Biomarkers of DNA damage in patients with end-stage renal disease: mitochondrial DNA mutation in hair follicles

BACKGROUND

DNA damage was noted in patients with end-stage renal disease (ESRD). Mitochondrial DNA (mtDNA) mutations have been proposed as a genomic biomarker in the process of human ageing, degenerative diseases and carcinogenesis.

METHODS

Polymerase chain reaction (PCR) techniques were applied to detect mtDNA deletions in hair follicles, an appendage of skin, from 162 patients with ESRD.

RESULTS

The incidences of the 4977 bp deletion of mtDNA in hair follicles were found to increase with age in normal control and ESRD patients. As compared with normal subjects, ESRD patients had 3.5, 2.3, 2.7, 2.3 and 1.4 times higher incidences of the 4977 bp deletion of mtDNA in the age groups of 20-30, 31-40, 41-50, 51-60 and 61-70 years, respectively. Moreover, the difference in the proportion of mtDNA with the 4977 bp deletion was statistically significant between ESRD patients and normal subjects >50 years of age.

CONCLUSION

We suggest that the 4977 bp deletion of mtDNA in hair follicles may serve as one of the tissue biomarkers of genetic instability of the mitochondrial genome in ESRD patients.

The growth effects of gamma-ray irradiation on third-stage larvae of Angiostrongylus cantonensis in snail

In order to clarify growth effects of gamma-ray irradiation on the third-stage larvae of Angiostrongylus cantonensis, snails naturally infected with larvae of A. cantonensis were irradiated with a cobalt-60 source, and the total dosage of exposure was 0.1 kGy. Third-stage larvae were collected from each group of irradiated and non-irradiated snails and then administered to rats. A significant reduction was observed in the number of recovery worms from rats sacrificed at 45 days after infection compared with the control group. Moreover, there was an increase in the percentage of female worms, and the body length of the irradiated group's worms was significantly shorter than that of the control group. In ultrastructural observations by transmission electron microscope, the cuticle was thickened and the subcuticle showed partial vacuolization and separation from muscle in the irradiated group. In addition, the muscles myofibril became shorter, the microvilli of intestinal mucosa were shorter and irregular, the terminal web disappeared, and the phagocytic vesicles, mitochondria, lysosomes and secretion granules decreased in number, respectively. Focusing on the mitochondria of the epithelial cells of the intestine, there were degenerative changes in the irradiated group showing vacuolization. The gonads of female worms recovered from the irradiated group revealed degenerative vacuolization, and the gonads of male worms could not be found.

Visual activation in functional magnetic resonance imaging at very high field (4 Tesla)

OBJECTIVES

Functional magnetic resonance imaging (fMRI) at very high field strengths provides functional brain mapping with the enhanced signal to noise ratio and the larger blood oxygenation level-dependent (BOLD) effect. We report activated areas in the standard space detected by fMRI at 4 Tesla (T) during simple visual stimulation.

MATERIALS AND METHODS

Twelve healthy young subjects were scanned using a 4 T scanner during binocular flashing visual stimulation. Functional images were realigned to the first scan and then spatially normalized. Individual and group data analyses were performed to identify areas of visual activation.

RESULTS

Activation of the bilateral primary visual cortex (V1/V2) was observed along the entire calcarine fissure in all subjects. The activated area extended to the extrastriate cortex in all subjects. Activation of the bilateral lateral geniculate nucleus (LGN) was detected in all subjects. The group data showed activation of the bilateral primary visual cortex and the bilateral lateral geniculate nucleus.

CONCLUSIONS

Robust activation of the vision-related areas was successfully obtained in all subjects using a 4 T magnetic resonance scanner. These results suggest that fMRI at very high field strengths may be effective in showing visual system physiology, and that it can be a promising method to assess visual function of human subjects.

VP22 enhanced intercellular trafficking of HSV thymidine kinase reduced the level of ganciclovir needed to cause suicide cell death

BACKGROUND

The inefficiency of herpes simplex virus thymidine kinase (TK) gene transfer and toxicity of ganciclovir (GCV) at high concentrations in vivo limits the use of this suicide gene therapy approach for the treatment of cancers in clinical settings. To overcome the problem, we have sought evidence of amplification of cytotoxicity by co-transfer of the TK gene fused with the gene encoding HSV-1 structural protein VP22 which has a remarkable ability for intercellular trafficking.

METHODS

The expression of the fusion proteins from the chimeric VP22-TK or VP22-EGFP genes was shown by Western blot and VP22 promoted TK or EGFP intercellular trafficking by an indirect immunofluorescent assay. The cytotoxicity was demonstrated by a colorimetric cell proliferation assay followed by an assessment of the bystander effect on admixtures of transfected with non-transfected naive cells.

RESULTS

Our results show the expression of the VP22 fusion proteins and their spread to varying numbers of bystander cells (up to 30, observed in viable cells with VP22-EGFP as well as after methanol fixation), confirming that VP22 assisted intercellular trafficking of the fusion proteins. This VP22 promoted TK spreading resulted in killing by 2.5 microg/ml GCV of virtually all cells in cultures that had been transfected at an efficiency of only 27.5%. In contrast, fewer than 80% of cells were killed when transfected with 'tk alone' at the same efficiency. The cell killing effect was exponentially dependent on GCV concentration in cells transfected with 'tk alone' at GCV concentrations between 0.25 and 0.5 microg/ml, but not those transfected with VP22-TK, probably due to the continuously variable, high sensitivity of about 50% of cells. Even at low concentration of GCV (0.2 microg/ml), the enhancement of cell killing by VP22 was four-fold higher in cells transfected with VP22-TK than in cells transfected with 'tk alone'.

CONCLUSIONS

VP22 enhanced intercellular trafficking of TK and amplified the TK/GCV killing effect, especially in the lower range of GCV concentrations. This offers a new strategy to enhance the effectiveness of suicide gene therapy for the treatment of cancers.

Cecal perforation presenting as abdominal-wall necrotizing fasciitis

The preoperative diagnosis of a cecal perforation associated with Salmonella infection as a cause of abdominal-wall necrotizing fasciitis (AWNF) is clinically difficult. Computed tomography of the abdomen is helpful, and can detect the combined presence of a pneumoscrotum and pneumoperitoneum. Its presence indicates a patent processus vaginalis, which acts as the primary route for the spread of the intra-abdominal infectious process into the abdominal wall. An exploratory laparotomy should be done to confirm the presence of intra-abdominal pathology in order to avoid delayed treatment.

Expression of HER-2/NEU oncoprotein in familial and non-familial breast cancer

The HER-2/neu proto-oncogene amplification or oncoprotein overexpression is an important prognostic factor and a predictive factor for resistance to endocrine therapy and adjuvant chemotherapy in breast cancers. Moreover, it is an entry criterion in the assessment of patients for whom Herceptin (Trastuzumab) treatment is considered. The overexpression rate of HER-2/neu oncoprotein has been identified in 10% to 40% of human breast cancers. In Taiwan, a higher grade of pathobiologic characteristics of familial breast cancer was also noted than that found in the non-familial group. It is worthwhile to evaluate whether the overexpression is more frequent in familial breast cancers. Fifty-six familial and 111 non-familial breast cancers were studied between 1990 and 1999 to assess both the overexpression of HER-2/neu oncoprotein immunohistochemically and the correlation with the histological type, grade and stage of breast carcinoma. The overexpression rate is higher in the familial breast cancer group (50.0%) when compared with non-familial breast cancer group (36.9%), which did not prove to be statistically significant (P = 0.1068). However, when the infiltrating ductal carcinomas of both groups are compared, it is statistically significant (52.3% vs. 33.7%, P = 0.0429). Overexpression correlated with node status and histological grade of infiltrating ductal carcinomas in non-familial and overall breast cancers. It also correlated with nuclear pleomorphism and mitotic counts, but not tubule formation or tumor size. All 3 cases of Paget's disease revealed overexpression, whereas all 12 cases of mucinous and one case of metaplastic carcinoma and one case of medullary carcinoma were negative. The overexpression rate was higher both in familial and non-familial intraductal carcinomas (57.1% vs. 73.3%, P = 0.4716). No statistical difference was identified between the 2 subsets. A case of infiltrating ductal carcinoma combined with intraductal carcinoma revealed heterogeneous staining in the component of ductal carcinoma in situ, while the invasive component did not. This suggests that overexpression decreases within individual tumors as they evolve from in situ to invasive lesioins. The HER-2/neu may imply a different role in intraductal carcinoma, Paget's disease and invasive duct carcinoma. Although the overexpression rate of HER-2/neu oncoprotein of familial breast cancer was not significantly higher than that of the non-familial group, it is appropriate to evaluate the rate of HER-2/neu overexpression according to the histological type of breast cancers from familial breast cancer and non-familial breast cancer. The prognoses will be needed for future evaluation.

Comparison of MALT and non-MALT primary large cell lymphoma of the stomach: does histologic evidence of MALT affect chemotherapy response?

BACKGROUND

Although the clinicopathologic features of low grade gastric MALToma (lymphoma of mucosa-associated lymphoid tissue) recently have been well delineated, the significance of identifying histologic evidence of MALT origin in a primary high grade gastric lymphoma is less clear. The authors sought to address this issue and, in particular, to clarify if MALT and non-MALT primary large cell gastric lymphoma might have a different response to systemic chemotherapy.

METHODS

The authors reviewed the pathologic specimens of all patients who had a diagnosis of primary large cell lymphoma of the stomach and who had been treated primarily by systemic chemotherapy in our institutions January 1, 1988-December 31, 1998. The patients were divided into two groups by experienced hematopathologists, based on the presence or absence of histologic features suggestive of MALToma, including typical lymphoepithelial lesions and infiltration of characteristic centrocyte-like cells. Disease staging was done according to the AJCC/UICC system with Musshoff modification. The median number of gastric biopsies for each patient was 7 (range, 1-21).

RESULTS

Seventeen patients with and 26 patients without histologic evidence of MALToma were identified. Clinical features were similar between the two groups except that a greater proportion of patients without evidence of MALToma had elevated levels of serum lactate dehydrogenase (50% vs. 12%, P = 0.01). The median duration of follow-up for the 43 patients was 46.5 months (range, 17-124 mos). All patients received standard systemic chemotherapy including anthracyclines or anthracenedione. The response rate was 88.2% for patients with evidence of MALToma and 57.7% for those without (P = 0.03). The 5-year overall survival rate was 80.5% for patients with evidence of MALToma and 48.9% for those without (P = 0.02). Multivariate analysis indicated that response to chemotherapy, disease stage (Stage I and II-1 vs. Stage II-2, III, and IV), and the presence of MALToma features were independent prognostic factors for overall survival.

CONCLUSION

The results of this relatively small study series suggested that the presence of histologic features of MALToma in patients with primary large cell gastric lymphoma might have been associated with a better response to systemic chemotherapy and a better prognosis. Further studies to consolidate this conclusion are necessary.

University students' attitudes towards mental patients and psychiatric treatment

BACKGROUND

Public attitudes towards mental patients and psychiatric treatment are mostly unfavorable. Mental patients tend to conceal their illness or selectively disclose their treatment histories to someone they trust.

AIMS

To examine the university students' attitudes towards different information regarding a person labeled as mentally ill.

METHODS

We designed seven descriptions of a mentally ill person of varying past and current treatment histories and randomly assigned 308 university undergraduates to read one of the descriptions. Subjects rated their willingness to interact with the hypothetical case using a 19-item social distance scale.

RESULTS

Greater social distance was associated with non-medical field of study, no previous contact with the mentally ill and female gender. Subjects without previous contact with mentally ill individuals kept greater distance from a discharged mental patient receiving psychiatric care than a mental patient who did not require medications nor psychiatric follow-up. In contrast, respondents who had previous contact with the mentally ill were more willing to interact with a discharged mental patient receiving psychiatric care comparing with a person labeled as mentally ill alone and a mental patient who had never been admitted to hospital.

CONCLUSIONS

Implications of our findings in clinical management and designing stigma-reducing programme are discussed.

Hypertension and its related factors in Taiwanese elderly people

BACKGROUND

Our study used data collected in Chung-Hsing Village in May 1998 to evaluate the prevalence of hypertension and its correlates in Taiwanese elderly people.

METHODS

All of individuals aged 65 and over were recruited as study subjects. A total of 1,093 persons, out of 1,774 registered residents, were contacted by face-to-face interview The response rate was 61.6 percent. However, only 586 respondents had blood tests and completed questionnaires. Analysis in this study was based on these 586 subjects. In order to study the significant correlates of hypertension, the t-test, chi-square analysis, and multivariate logistic regression were used.

RESULTS

Our results showed that 66 percent were men and 34 percent were women. The mean age was 73.1 +/- 5.3 years. The proportions of hypertension were 53.09 percent in men and 56.06 percent in women (p > 0.05). After controlling the other covariates, the multivariate logistic regression analysis showed that the significant related factors of hypertension were obesity (OR = 1.88, 95 percent CI = 1.06-3.34, p < 0.05) and renalfunction impairment (OR = 1.69, 95 percent CI = 1.02-2.80, p < 0.05).

CONCLUSIONS

The prevalence of hypertension was high in elderly people. Hypertension is significantly associated with obesity and renalfunction impairment in elderly people.

Functional magnetic resonance imaging of lateral geniculate nucleus at 1.5 tesla

Although activation of the lateral geniculate nucleus has been detected by functional magnetic resonance imaging with magnetic field strengths higher than 2.0 Tesla, there have been no reports of functional magnetic resonance imaging of the lateral geniculate nucleus with the more widely available 1.5 Tesla scanner. The authors used functional magnetic resonance imaging techniques at 1.5 Tesla to detect lateral geniculate nucleus activation in five of seven healthy subjects. This study shows that visual activation of the lateral geniculate nucleus can be obtained with functional magnetic resonance imaging using conventional 1.5 Tesla scanners.

Optical cylinder designs to increase the field of vision in the osteo-odonto-keratoprosthesis

BACKGROUND

The single optical cylinders used in the osteo-odonto-keratoprosthesis (OOKP) are known to produce very small visual fields. Values of 40 degrees are typically quoted. The purpose of this paper is to present designs for new optical cylinders that significantly increase the field of view and therefore improve the visual rehabilitation of patients having an OOKP.

METHODS

Computer ray-tracing techniques were used to design and analyse improved one- and two-piece optical cylinders made from polymethyl methacrylate. All designs were required to have a potential visual acuity of 6/6 before consideration was given to the visual field and optimising off-axis image quality. Aspheric surfaces were used where this significantly improved off-axis image quality.

RESULTS

Single optical cylinders, with increased posterior cylinder (intraocular) diameters, gave an increase in the theoretical visual field of 18% (from 76 degrees to 90 degrees) over current designs. Two-piece designs based on an inverted telephoto principle gave theoretical field angles over 120 degrees. Aspheric surfaces were shown to improve the off-axis image quality while maintaining a potential visual acuity of at least 6/6. This may well increase the measured visual field by improving the retinal illuminance off-axis.

CONCLUSIONS

Results demonstrate that it is possible to significantly increase the theoretical maximum visual field through OOKP optical cylinders. Such designs will improve the visual rehabilitation of patients undergoing this procedure.

Simplified 13C-urea breath test for the diagnosis of Helicobacter pylori infection--the availability of without fasting and without test meal

The conventional 13C-urea breath test (13C-UBT) for detecting Helicobacter pylori infection was performed during fasting state and with a test meal to delay gastric emptying during the test. For the convenience of propagating this test, we assessed the availability of non-fast and without test meal in 13C-UBT for the diagnosis of H. pylori infection. One hundred and five consecutive patients who received endoscopic examination were studied. All of them received endoscopic biopsy for urease test, culture and histopathology to determine whether there was a presence of H. pylori infection. Each patient received four separate 13C-UBT under the following four testing conditions. Test I) fasting state with test meal (100 ml fresh milk), Test II) non-fast (taking usual food) but with test meal, Test III) fasting state without test meal, and Test IV) non-fast and without test meal. The excess delta 13CO2 values were calculated via the breathed samples that were collected at 15 minutes after ingestion of 13C-urea. There were 61 H. pylori positive and 44 negative patients in this study, with an excess delta 13CO2 values 3.0, 4.0, 3.5 and 4.0 as a cut-off value in the four tests respectively, according to the ROC curve. The results of test I, a conventional procedure, had a good correlation with the gold standard. The sensitivity and specificity were 100% and 95% respectively. The alternative procedures in other tests also have high sensitivity and specificity at 15-minute detecting time. The sensitivity of the tests II, III and IV at 15-minute detecting times were 98%, 98% and 100%, and the specificities of those were 95%, 98% and 95% respectively. We therefore suggest that fasting and test meal possibly be omitted when the cut-off value is 4.0 per mil in the simplified 13C-UBT (non-fast and without test meal, and detection at 15 minutes after ingestion of 13C-urea) which is a simple and available procedure for clinical diagnosis of H. pylori infection.

Flexible iris hooks for phacoemulsification in patients with iridoschisis

Flexible iris hooks, or retractors, can be used to facilitate cataract removal by phacoemulsification in patients with primary iridoschisis. This rare condition is associated with fibrillary degeneration of the iris, narrow drainage angles, and cataract. In addition to their conventional use as iris retractors, iris hooks can control the degenerate fibrillary iris stroma to improve the view and access to the lens, preventing further damage during phacoemulsification and cortical cleanup. Iris hooks are widely available, easily handled, and can transform a difficult case into one that is almost routine.

Splice site mutation in the type VII collagen gene (COL7A1) in a Taiwanese family with recessive dystrophic epidermolysis bullosa

BACKGROUND AND PURPOSE

Generalized recessive dystrophic epidermolysis bullosa (RDEB) is a severe inherited disease, in which patients suffer from blistering and scarring of the skin and mucous membranes after minor mechanical trauma. Tight genetic linkage has been established to the type VII collagen gene (COL7A1) at 3p21. The purpose of this study was to identify mutations in COL7A1 in one Taiwanese pedigree with generalized RDEB.

METHODS

Genomic DNA was used as the template for polymerase chain reaction (PCR) amplification of all 118 COL7A1 exons and the flanking splice junctions. PCR was followed by heteroduplex analysis of the products by single-strand conformation polymorphism (SSCP) studies, and direct nucleotide sequencing was used to search for mutations, which were verified by restriction endonuclease digestion.

RESULTS

We identified a homozygous intronic splice-site at the +1 position of intron 5 (682 + 1G-->A) of COL7A1 in the affected individual. His parents, who were cousins, were not affected by this disease. The mother was heterozygous for the mutation; the father had died before the study, of unrelated causes. This mutation results in a frameshift and downstream stop codons on both alleles, indicating an absence of functional protein. Restriction endonuclease BspHI can be used to verify this mutation and screen other members in the same family.

CONCLUSIONS

These molecular findings offer a genetic explanation for the skin fragility in this Taiwanese patient with RDEB. The immediate benefits gained by elucidating mutations in family members include the ability to assess whether they are carriers of this disease and the ability to use this DNA-based method for prenatal testing in subsequent pregnancies.

Familial breast cancer in southern Taiwan

The purpose of this study is to evaluate whether there are pathobiologic differences and differences in overall rates survival between familial and non-familial breast cancer patients in Taiwan. A retrospective study was performed evaluating 76 familial breast cancer patients in 69 families, which included two BRCA1 related cases and six BRCA2 related cases. Patients were compared with 425 non-familial sporadic cases. Familial breast cancer patients had similar ages and stages as non-familial patients (mean, 46.6 years vs 48.9 years, p = 0.306). However, the familial breast cancer patients with BRCA1 and BRCA2 related cases presented at lower stages (p = 0.034) and younger ages than non-familial patients (mean, 45.1 years vs 48.9 years P = 0.042). The occurrence of infiltrating ductal carcinoma and lobular carcinoma in situ was not significantly different in the two groups. Mucinous carcinoma was represented with 6.7% (4/76) and 1.3% (1/76) medullary carcinoma. The overall grade of familial breast cancer, including BRCA1 and BRCA2 related cases in 8 infiltrating ductal carcinoma, was significantly higher than that of controls. The mean follow up was 4.5 years for familial breast cancers. Five- and 10-year overall survival rates were 69% and 61% for those with a family history, compared with 86% and 64% for those in the control group (p = 0.644). There were no statistically significant differences in disease-free survival rates between the two groups at 5 or 10 years (69% vs 78% in 5 years; 48% vs 58% in 10 years) (p = 0.862). Despite the younger ages and earlier stages at presentation in familial breast cancer patients with BRCA1 and BRCA2 related cases, the familial breast cancer patients had higher grade patholobiologic characteristics, but similar prognoses when compared with sporadic breast cancer patients. Owing to the limited number of familial cases in this study, more cases and longer follow up are needed.