Cytochrome P4501A1 polymorphism as a susceptibility factor for breast cancer in postmenopausal Chinese women in Taiwan

The incidence of breast cancer has been greatly increasing in Taiwan over the past two decades. Since cytochrome P4501A1 (CYP1A1) is involved in the metabolism of environmental carcinogens or oestrogen, we hypothesized that CYP1A1 genetic polymorphism may be a susceptibility factor for breast cancer. This hypothesis was evaluated in this case control study of 150 breast cancer patients and 150 healthy controls among Chinese women. Two CYP1A1 polymorphisms were studied, one containing a new Msp1 site and the other located in axon 7 and resulting in the replacement of an isoleucine (Ile) residue by a valine (Val). After simultaneously considering the known or significant risk factors for breast cancer, including the age of study participants, positive family history of breast cancer, early menarche (< or = 13 years), nulliparity and late first full-term pregnancy (> or = 30 years), hormone replacement therapy and smoking, the CYP1A1 Msp1 polymorphism was found to be a significant factor in determining the risk of breast cancer. The homozygous variant was the most susceptible genotype with an adjusted odds ratio of 1.98 (95% confidence interval (CI) = 1.01-3.99) compared with the non-homozygous variants (the homozygous wild-type and the heterozygous variant). In contrast, the CYP1A1 Ile/Val polymorphism was not significantly associated with breast cancer development (adjusted OR = 1.07, 95% CI = 0.64-1.78). Interestingly, the Msp1 polymorphism was especially significant in postmenopausal women, but not in premenopausal women. Further stratification analysis in postmenopausal women who were non-smokers and with no history of hormone replacement therapy showed the cancer risk due to the Msp1 variant to be more significant in women with early menarche. We conclude that CYP1A1 polymorphism is a susceptibility factor for breast cancer in postmenopausal Chinese women in Taiwan. Further study with a large sample size should be considered to address issues of interactions between CYP1A1 and other risk factors.

Association between N-acetyltransferase 2 (NAT2) genetic polymorphism and development of breast cancer in post-menopausal Chinese women in Taiwan, an area of great increase in breast cancer incidence

The incidence of breast cancer has increased greatly in Taiwan over the past 2 decades. Increased exposure to environmental carcinogens, including aryl aromatic amines, as a result of the economic boom, is suspected to be one factor contributing to this increase. The enzyme N-acetyltransferase 2 (NAT2) determines the rate of metabolism of aryl aromatic amines, and therefore the NAT2 slow acetylator genotype is associated with an increased risk of cancer. Our present case-control study of 150 breast cancer patients and 150 healthy controls in Taiwan was performed to explore the association between NAT2 genetic polymorphism and individual susceptibility to breast cancer. A structured questionnaire was used to collect relevant information regarding all known or suspected risk factors of breast cancer. The NAT2 genotype was determined using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay in 139 cases and 133 controls, and 28.8% and 21.1%, respectively, were found to have slow acetylator genotypes. Multivariate analysis, simultaneously considering other risk factors, including age at menarche, nulliparity or age at first full-term pregnancy, body mass index (BMI), hormone replacement therapy (HRT) and smoking status, showed that the NAT2 slow acetylator genotype was associated with an increased risk with borderline significance (Odds Ratio, 1.81; 95% CI, 1.01-3.31). Interestingly, this association was not significant in premenopausal women, but was significant in post-menopausal women. Further stratification of our study subjects based on different risk factor status showed that the increased risk for an NAT2 slow acetylator was more marked in post-menopausal women who were not using HRT or who had a lower BMI. Our findings suggest that NAT2 polymorphism is a susceptibility factor for breast cancer in Taiwanese women, and that NAT2-metabolized carcinogens are probably present in the environment and may be associated with induction of breast cancer.

Temporomandibular joint reconstruction in children using costochondral grafts

PURPOSE

The aim of this study was to evaluate the postoperative growth of the mandible after reconstruction of the condylar process using costochondral grafts in children.

PATIENTS AND METHODS

Temporomandibular joint (TMJ) ankylosis was surgically treated and the joint reconstructed with a costochondral graft (CCG) in two boys and eight girls with a mean age of 7.4 years. Two children had bilateral ankylosis. Postoperative changes and craniofacial growth were monitored by lateral and posteroanterior (PA) cephalograms annually from 2 to 6 years (mean of 4 years).

RESULTS

Postoperatively, in the eight children with unilateral TMJ reconstruction, the mandible (Co-Gn) grew an average of 14.7 mm in length on the affected side and 15.1 mm on the nonaffected side; ramus length (Co-Go) increased an average of 7.1 mm on the affected side and 7.3 mm on the nonaffected side. However, in five of the children the chin progressively deviated toward the nonaffected side after TMJ reconstruction. The CCGs tended to have a more vertically directed condylar growth pattern and a more laterally positioned condyle. In the two cases with bilateral TMJ reconstruction, the CCGs grew until there was a mandibular prognathism that required orthognathic surgery to set back the mandible.

CONCLUSIONS

Using CCGs to reconstruct TMJ ankylosis in children provides a functional condyle with growth potential. However, there is a possibility of excessive growth of the graft, resulting in deviation of the chin and mandibular prognathism years later.

Nosocomial gram-negative bacteremia in critically ill patients: epidemiologic characteristics and prognostic factors in 147 episodes

Although gram-positive organisms are the most common causes of nosocomial bloodstream infections, gram-negative bacteremia carries higher risks of severe sepsis, septic shock, and death among critically ill patients in intensive care units (ICUs). We performed a prospective epidemiologic analysis of nosocomial gram-negative bacteremia episodes among ICU patients and sought to identify risk factors for mortality among these patients. All episodes of nosocomial gram-negative bacteremia documented in five ICU wards of our hospital during a 2-year period were included. There were 147 episodes (124 patients) of gram-negative bacteremia documented during the study period. The overall mortality rate was 36.1%, and 77.4% of all deaths were directly related to the bloodstream infection. Gram-negative bacteremia was associated with prolonged ICU stay (45.7 d vs 6.1 d for all ICU patients). The most common isolate was Acinetobacter baumannii, followed by Burkholderia cepacia and Enterobacter cloacae. The most frequent source of infection was the lower respiratory tract (32.0%). Of the agents tested, ciprofloxacin, imipenem, and ceftazidime were the most active against the clinical isolates. Multivariate logistic regression analysis identified the presence of septic shock (odds ratio, OR = 17.66, p < 0.001) and rapidly fatal and ultimately fatal underlying conditions (OR = 3.47, p = 0.032) as being independent risk factors for mortality. Early appropriate antibiotic treatment did not result in significant improvement in survival. These findings suggest that prevention of lower respiratory tract colonization and nosocomial pneumonia are crucial for reducing the incidence of nosocomial gram-negative bacteremia in the ICU. Serious underlying illnesses and septic shock were the most important risk factors for death in these patients.

p27 expression as a prognostic factor of breast cancer in Taiwan

p27Kip1 is a member of the Cip/Kip family of cyclin-dependent kinase inhibitors. It binds to a variety of cyclin/CDK complexes, inhibits kinase activity, and blocks the cell cycle. Absent or reduced p27 expression has been shown to be a significant predictor of poor survival in breast, colorectal, prostate, non-small cell lung and esophagus carcinomas. An immunohistochemical assay was performed on 169 patients with primary breast cancers to evaluate the biologic significance of p27 expression. Decreased p27 expression was significantly associated with high grade (P = 0.00025), negative estrogen receptor (P = 0.00004), and negative progesterone receptor (P = 0.0038) breast cancers. Univariate analysis reveals that p27 expression inversely correlated significantly with overall survival (P = 0.0001). By multivariate analysis, p27 predicted the overall survival independently (P = 0.0096). Our study indicates that p27 expression is an independent prognostic marker of breast cancer in Taiwan.

Microcalcifications of non-palpable breast lesions detected by ultrasonography: correlation with mammography and histopathology

OBJECTIVES

Microcalcifications are generally not demonstrated well on ultrasonography. In this study, we attempted to demonstrate the usefulness of high-resolution ultrasonography in the detection of microcalcifications associated with non-palpable breast cancers.

DESIGN

Fourteen patients with non-palpable breast lesions in whom microcalcifications were detected or suspected by ultrasonography and one patient in whom microcalcifications were detected on mammography only were included in the study. Mammography and analysis of biopsy specimens were performed in each patient and the findings were correlated with the ultrasonographic findings. Ultrasonography and mammography were performed independently by different physicians at different times.

RESULTS

In three patients < or = 30 years of age, who were not at high risk of breast cancer and who had no evidence of cancer on palpation, high-resolution ultrasonography clearly showed microcalcifications but no mass. Two of these patients had ductal carcinoma in situ and one had small invasive carcinoma with extensive comedocarcinoma. Among the other 12 patients with non-palpable breast lesions, ultrasonography detected microcalcifications accurately in six and suggested possible microcalcifications in a further four. Microcalcifications in all of these ten patients were confirmed by mammography thereafter. Four of these ten patients had ductal carcinoma in situ, with or without invasive carcinoma. Of the remaining two patients, one demonstrated false-positive findings and one false-negative findings on ultrasound. On high-resolution ultrasonography, microcalcifications produced the appearance of twinkling stars (bright dots in different planes) in a dark sky (contrasted against ill-defined hypoechoic patches), corresponding on histopathology to groups of expanded ducts with increased cell density with or without necrosis.

CONCLUSION

High-resolution ultrasonography may be used for detection of microcalcifications in non-palpable breast lesions. Ultrasonography is helpful in screening for early breast cancers, especially in young patients who are at risk for breast cancer and in whom mammography is not usually carried out.

Palatoalveolar outcome at 18 months following simultaneous primary cleft lip repair and posterior palatoplasty

It is frequently reported that early repair of the soft palate induces narrowing of the remaining palatal cleft and thus facilitates later hard palate closure. However, to the best of our knowledge, there have been no comparative studies to test this hypothesis. The purpose of this retrospective study was to evaluate the change of palatoalveolar morphology following primary lip repair and posterior palatoplasty. Dental plaster models of patients with complete unilateral cleft of lip and palate (UCLP) were used to measure the width of the cleft and palatal arch. Twenty-six patients received simple posterior palatoplasty (PP group) simultaneous with primary lip repair, and 20 patients did not (NPP group). The dental models included one preoperative cast at 2 months (T1) and two or three casts at 6 (T2), 12 (T3), and 18 (T4) months before final palate closure. The linear measurements performed were width of alveolar cleft (Ca); width of palatal cleft between the canines (Cc), molars (Cm), and tuberosities (Ct); the palatal arch distance between the canines (Dc); the widest distance between molars (Dm) and the tuberosities (Dt); and the palatal height between the canines (Hc) and tuberosities (Ht). The raw measurements and the calculated cleft-to-arch ratios of Cc/Dc, Cm/Dm, and Ct/Dt were compared between the two groups. The results showed gradual narrowing of the width of cleft from T1 to T4. Narrowing of alveolar cleft width (Ca) from T1 to T2 was dramatic. The palatal arch (Dc, Dm, Dt) showed no change to mild increase in width. The cleft-to-arch ratios decreased with time. The palatal height remained the same or slightly increased over time. There were no significant differences observed between the PP and NPP groups among these measurements except for the Ct and Ct/Dt at T4. In conclusion, after initial lip repair, there was a decrease of the width of cleft in patients with complete UCLP during the 18-month period, and simple posterior palatoplasty did not further narrow the cleft nor influence palatal arch development.

Mandibular lengthening by distraction osteogenesis in children--a one-year follow-up study

OBJECTIVE

The present study was undertaken to document whether mandibular length could be increased by distraction osteogenesis in children and what happens to the mandibular position 1 year after the distraction.

METHODS

Five patients with hemifacial microsomia (four unilateral, one bilateral) had distraction osteogenesis performed to lengthen the mandible. All patients had cephalometric and panoramic radiographs obtained before and 3, 6, and 12 months after the distraction osteogenesis.

RESULTS

The total mandibular length (Co-Gn) on the affected side was increased by 11.2 mm after the distraction and remained stable during a 1-year observation period. However, the increased mandibular length tended to move the chin downward (8 mm) more than forward (2 mm) during the same period.

CONCLUSIONS

Distraction osteogensis can be used to lengthen the hypoplastic mandible. However, most of the increased mandibular length moved the chin downward more than forward.

Measurement of the quality of life during different clinical phases of breast cancer

This cross-sectional study was designed to evaluate the self-rated quality of life of Taiwanese breast cancer patients at the time of diagnosis and during various phases of treatment. A total of 115 patients at different clinical stages of breast cancer completed the study. The questionnaires consisted of the Medical Outcome Survey 36-Item Short Form Health Surveys (SF-36), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire--Cancer 30 (EORTC QLQ-C30), and questions measuring utility using visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) methods. The patients filled out the questionnaires, with interviewers' assistance as requested. Cronbach's alpha coefficients of internal consistency for the SF-36, based on the US factor structure, were 0.84 for raw scores and 0.87 and 0.88 for the physical and mental components, respectively. Cronbach's alpha for the EORTC QLQ-C30 was 0.86. The correlations between items in the SF-36 and the EORTC QLQ-C30 that examined similar dimensions were high. Significant differences were found in most dimensions of quality of life across different clinical stages. The three utility scores, however, showed no significant differences among patients in different clinical stages. Patients in the chemotherapy and recurrence phases usually had the lowest quality of life scores, while those in the follow-up phase had the highest. The results of this study demonstrate the applicability of quality of life measurements in helping health professionals identify the physical, mental, and social problems of breast cancer patients in different phases of the clinical process.

Prosthetic reconstruction in the cleft lip and palate patient with an extracoronal resilient attachment retained removable partial overdenture: case report

There are still some difficulties in prosthetic reconstruction of cleft lip and palate patients with conventional prostheses or implant retained prostheses. The most common difficulties are insufficient alveolar bone quality and quantity, inadequate soft tissue, and abutment teeth. The patient we report on was a 23-year-old man with a clinical diagnosis of right incomplete cleft lip and palate combined with midface dysplasia. The maxillary six anterior teeth were reconstructed. The maxillary right central incisor and canine were used as abutments for an extracoronal resilient attachment (ERA) retained removable partial overdenture. The STERN ERA SYSTEM is a hinged resilient attachment with an ideal stress breaking characteristic, a good retentive function, and easy chairside replacement. The 2-year follow-up examination revealed an adequate esthetic appearance with good retention and stability of the prosthesis. A removable partial overdenture using the teeth adjacent to the cleft area as abutments with an adequate attachment design is an alternative method for prosthetic reconstruction of cleft lip and palate deformity.

Surgical treatment of recurrent groin hernia

Recurrent groin hernia is not uncommon in Taiwan. Subsequent surgical repairs are difficult, due to cicartrization and deterioration of the inguinal floor. In this report, the intermediate and long-term outcomes of 212 patients with recurrent groin hernias who underwent surgical repair within a 10-year period were analyzed in order to assess the effectiveness of two modified repair techniques. Patients with unilateral first-time recurrent hernia (UR; n = 87) were treated by a modified Shouldice technique using an inguinal approach. Those with bilateral or multiple recurrences (MRs; n = 125) were treated with giant prosthetic reinforcement of the visceral sac (GPRVS, Stoppa operation) using a midline preperitoneal approach. Complete exploration of the groin floor on the side of recurrence revealed a high rate of direct space defects (UR, 41.5%; MR, 65%) and multiple posterior wall defects (UR, 29.9%; MR, 30%). In the UR group, a 4 x 10-cm preperitoneal prosthetic mesh was incorporated to reinforce the repair. For MR patients, I reduced the transverse dimension of the mesh prosthesis by 2 cm compared with the original Stoppa protocol; to reduce crinkling, the average dimensions were 23 x 14 cm. Complications in the UR group included testicular atrophy (3 patients) and femoral vein thrombosis (1). Complications in the MR group were transient scrotal fluid accumulation (9 patients), fatal perioperative acute myocardial infarction (1), and failure of the peritoneum to grow over the mesh (1). The average hospital stay was 3 days in the UR group and 6 days in the MR group. The long-term follow-up (1-9 years) revealed a 5.7% re-recurrence rate with an 86.2% follow-up rate in the UR group, and a 1.9% re-recurrence rate with an 86.6% follow-up rate in the UR group. I conclude that GPRVS is an excellent treatment for URs, but the transverse dimension of the prosthetic mesh should be reduced for Taiwanese subjects. However, for first-time MRs, a modified Shouldice technique with incorporation of a preperitoneal prosthetic mesh is still recommended. The surgical dissection is less extensive and the hospital stay is shorter, while the re-recurrence rate is acceptably low.

Allelic loss of the BRCA1 and BRCA2 genes and other regions on 17q and 13q in breast cancer among women from Taiwan (area of low incidence but early onset)

We have examined the role of the breast cancer susceptibility genes BRCA1 and BRCA2 and other loci in the vicinity of these 2 genes on the long arms of chromosomes 17 and 13 (17q and 13q) for the presence of genomic deletions in breast cancer among Taiwanese women. Breast cancer in Taiwan is particularly characterized by its low incidence rate and its early age of tumor onset. Twelve microsatellite markers spanning the region 17q12-21 and 8 microsatellite markers spanning the region 13q12-14 were analyzed for allelic loss or loss of heterozygosity (LOH) in 90 patients with primary infiltrating ductal carcinoma. Compared with the background LOH level (10-12%) estimated by LOH at 4 unrelated loci, 17 markers (11 at 17q and 6 at 13q) demonstrated a significantly increased frequency (21-42%) of allelic loss (p < 0.05). Subsequent construction of deletion maps based on LOH at these significant loci localized the 6 smallest regions of overlap, including those harboring BRCA1, BRCA2, the retinoblastoma gene and 3 novel regions (the 1st located approximately 0.5 to 1 cM telomeric to BRCA1, the 2nd centromeric to BRCA1 flanked by D17S857/D17S846 and the 3rd closely adjacent to BRCA2), suggesting sites of susceptibility genes. Allelic loss at BRCA1 and BRCA2 was specifically associated with poorly differentiated tumors.

The prognostic significance of tumor angiogenesis in Taiwanese patients with invasive ductal breast carcinomas

Angiogenesis plays an important role in tumor growth and metastasis. We performed an immunohistochemical study by anti-CD31 antibody to investigate the prognostic significance of microvessel count (MVC) in 163 Taiwanese patients with primary invasive ductal breast carcinomas. Univariate analysis revealed that MVC per 200x field correlated significantly with disease-free (P < 0.001) and overall survival (P < 0.0008). In 74 patients with node-negative tumors, MVC also significantly correlated with disease-free (P < 0.03) and overall survival (P < 0.007). Multivariate Cox regression analysis demonstrated that MVC is an independent factor in predicting disease-free (P < 0.02) and overall survival (P < 0.02). Our study confirms that tumor angiogenesis as measured by MVC is a reliable independent prognostic factor of breast cancer.

Premaxillary size and craniofacial growth in patients with cleft lip and palate

BACKGROUND

Premaxillary size in individuals with cleft lip and palate is variable, ranging from a mere nubbin to a large protuberance. The purpose of this study was to evaluate the effect of premaxillary size on craniofacial growth in cleft lip and palate patients.

MATERIALS AND METHODS

Premaxillary size was measured using 181 dental casts of bilateral complete cleft lip and palate (BCLP) infants. The infants had no associated systemic malformations, and were approximately one year of age. Data were obtained from the files of the Chang Gung Craniofacial Center. The mean size (mean = 19.3 mm) of the premaxilla and standard deviation (SD = 2.0 mm) were calculated. A sample of 55 subjects was divided into three groups: large premaxilla; [LP; 15 boys, 5 girls; mean age 5.2 years; premaxillary size > (19.3 + 2.0) mm; mean size 22.6 mm]; small premaxilla [SP; 15 boys, 5 girls; mean age = 5.1 years; premaxillary size < (19.3-2.0) mm; mean size = 16.5 mm] and bilateral-median facial dysplasia [B-MFD; 6 boys, 9 girls; mean age 5.1 years; mean size 10.5 mm]. They all had a bilateral cheiloplasty at about 3 months of age and palatoplasty at about one year of age. Lateral cephalograms were taken at about 5 years of age to compare the craniofacial complex among the three groups.

RESULTS

The LP group tended to have a longer maxilla, longer anterior maxillary height and more protruded maxilla, producing a better interjaw relation and larger overjet. The opposite phenomena were observed in the B-MFD group, and the SP group had results between those of the LP group and the B-MFD group.

CONCLUSION

BCLP patients with large premaxilla had superior maxillary growth (in depth and anterior height) as compared to those with small premaxilla.

Rapid canine retraction through distraction of the periodontal ligament

The process of osteogenesis in the periodontal ligament during orthodontic tooth movement is similar to the osteogenesis in the midpalatal suture during rapid palatal expansion. A new concept of "distracting the periodontal ligament" is proposed to elicit rapid canine retraction in 3 weeks. It is called dental distraction. Fifteen orthodontic patients (26 canines, including 15 uppers and 11 lowers) who needed canine retraction and first premolar extraction were included. At the time of first premolar extraction, the interseptal bone distal to the canine was undermined with a bone bur, grooving vertically inside the extraction socket along the buccal and lingual sides and extending obliquely toward the socket base. Then, a tooth-borne, custom-made, intraoral distraction device was placed to distract the canine distally into the extraction space. It was activated 0.5 to 1.0 mm/day immediately after the extraction. The anchor units were the second premolar and first molar. Cephalometric and periapical x-rays were taken before and after the canine retraction. Both the upper and lower canines were distracted bodily 6.5 mm into the extraction space within 3 weeks. New alveolar bone was generated and remodeled rapidly in the mesial periodontal ligament of the canine during and after the distraction. It became mature and indistinguishable from the native alveolar bone 3 months after distraction. During the distraction, 73% of the first molars did not move mesially and 27% of them moved less than 0.5 mm mesially within 3 weeks. The radiographic examination revealed that apical or lateral surface root resorption of the canine was minimal. No periodontal defect or endodontic lesion was observed throughout and after distraction. We concluded that the periodontal ligament could be rapidly distracted without complications. The rapid orthodontic tooth movement through distracting the periodontal ligament cannot be emulated by current conventional orthodontic concepts and methods.

Proliferating cell nuclear antigen (PCNA) immunolabeling as a prognostic factor in invasive ductal carcinoma of the breast in Taiwan

To evaluate the prognostic significance of proliferating cell nuclear antigen (PCNA) in breast cancer, an immunohistochemical assay was performed in 150 patients with invasive ductal carcinomas. The PCNA labeling index (PCNA-LI) was classified into two subgroups at a cut-off point of 45% that gave the best prognostic estimates for PCNA in survival analyses. Seventy-eight tumors had a low PCNA-LI of < or =45% and 72 tumors had a high PCNA-LI of >45%. A high PCNA-LI correlated significantly with p53 overexpression (P<0.03), positive axillary node (P<0.04), short disease-free survival (P<0.001) and overall survival (P<0.0002), but not with other factors. In multivariate analysis, the PCNA-LI predicted the disease-free (P<0.008) and overall survival (P = 0.0007) independently. Our study indicates that the PCNA-LI has independent prognostic value.

HBV core promoter mutations prevail in patients with hepatocellular carcinoma from Guangxi, China

The development of primary liver cancer frequently is associated with persistent HBV infection, and tumours may arise in individuals who are anti-HBe positive. However, it is unclear whether viruses with an HBeAg-negative phenotype are associated with tumour development or are selected, during seroconversion, after chromosomal integration of wild-type viral DNA. In order to investigate the temporal evolution of the HBV genome in such individuals, the polymerase chain reaction was used to amplify HBV DNA from tumour tissue and serum of 14 patients from Guangxi, China with hepatocellular carcinoma. Comparison of nucleotide and amino acid sequences of the precore and proximal core region of HBV from the two sites in each patient produced evidence of divergence following integration in the tumour, but in most cases, HBeAg-negativity could not be explained by precore mutations. Sequences from the core promoter region were therefore examined and mutations were found in the majority, which are believed to upregulate transcription of the core (and pregenomic) RNA but to downregulate precore mRNA. To determine whether this finding merely reflected sequence variation among geographical isolates of HBV, the same region of HBV DNA from asymptomatic controls was sequenced and these mutations were found to be rare. We hypothesise that HBV with the core promoter mutations replicates at higher levels than the wild type, with the consequence that more integrations occur into the hepatocyte chromosomes during the early stages of infection. These hepatocytes may expand clonally and be targets for further mutagenic events leading to tumour development.

Oral contraceptives and breast cancer risk in Taiwan, a country of low incidence of breast cancer and low use of oral contraceptives

One hundred and seventy four (81% of all) pathologically confirmed new incident cases of female breast cancer identified from a medical center in Taipei from February, 1993 to June, 1994 were selected as the case group. Four hundred and fifty three inpatient controls who were without obstetric-gynecological, breast, or malignant diseases were individually matched for each case by age and date of admission. Information was obtained through direct interview and review of medical records. Conditional logistic regression was used to estimate the effects of each risk factor. After adjusting for education level, body mass index, age at menarche and first full-term pregnancy, parity, menopausal status and age at menopause, lifetime lactation, use of lactation inhibition hormones, and family history of breast cancer, breast cancer risk significantly elevated in use of OC before 25 years old and before 1971. In stratified analysis, significantly higher risk were found in OC use before 25 years old and in duration of use less than one year among post-menopausal subjects. Our results support the notion that OC use in early life for younger women and in early calendar years increase breast cancer risk.

Phase I trial of a human-mouse chimeric anti-disialoganglioside monoclonal antibody ch14.18 in patients with refractory neuroblastoma and osteosarcoma

PURPOSE

To evaluate the toxicity, immunogenicity, and pharmacokinetics of a human-mouse chimeric monoclonal antibody (mAb) ch 14.18 directed against disialoganglioside (GD2) and to obtain preliminary information on its clinical efficacy, we conducted a phase I trial in 10 patients with refractory neuroblastoma and one patient with osteosarcoma.

PATIENTS AND METHODS

Eleven patients were entered onto this phase I trial. They received 20 courses of mAb ch 14.18 at dose levels of 10, 20, 50, 100, and 200 mg/m2. Dose escalation was performed in cohorts of three patients; intrapatient dose escalation was also permitted.

RESULTS

The most prevalent toxicities were pain, tachycardia, hypertension, fever, and urticaria. Most of these toxicities were dose-dependent and rarely noted at dosages of 20 mg/m2 and less. Although the maximum-tolerated dose was not reached in this study, clinical responses were observed. These included one partial (PR) and four mixed responses (MRs) and one stable disease (SD) among 10 assessable patients. Biologic activity of ch 14.18 in vivo was shown by binding of ch 14.18 to tumor cells and complement-dependent cytotoxicity of posttreatment sera against tumor target cells. An anti-ch 14.18 immune response was detectable in seven of 10 patients studied.

CONCLUSION

In summary, with the dose schedule used, ch 14.18 appears to be clinically safe and effective, and repeated mAb administration was not associated with increased toxicities. Further clinical trials of mAb ch 14.18 in patients with neuroblastoma are warranted.

Distribution patterns of primary and permanent dentition in children with unilateral complete cleft lip and palate

OBJECTIVE

To investigate the distribution patterns of primary and permanent teeth in the cleft area and the numerical variation in teeth in unilateral complete cleft lip and palate (UCLP) patients.

DESIGN

A survey of the dentition in UCLP patients.

SETTING

Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan.

PATIENTS

137 UCLP patients who met the following criteria: (1) have had at least one panoramic film taken, (2) the first panoramic film illustrates either primary or early mixed dentition. Evaluation of both permanent and primary dentition was available in 91 cases.

MAIN OUTCOME MEASURES

Two evaluators performed independent evaluations of number and distribution of teeth in UCLP patients. The hypothesis that there are two odontogenic origins for maxillary lateral incisors was proposed to explain the occurrence of distribution patterns of dentition in the cleft area and to explain differences between primary and permanent dentition in UCLP patients.

RESULTS

Four distribution patterns in the cleft area were identified in both the primary and the permanent dentition. In the primary dentition, placement of the lateral incisor distal to the alveolar cleft was the predominant pattern (pattern y, 82.4%), followed by absence of the cleft side maxillary lateral incisor (pattern ab, 9.9%), presence of one tooth on each side of the alveolar cleft (pattern xy, 5.5%), and placement of the lateral incisor mesial to the alveolar cleft (pattern x, 2.2%). In the permanent dentition, the most common pattern was the absence of the maxillary lateral incisor on the cleft side (pattern AB, 51.8%), followed by lateral incisor placement distal to the alveolar cleft (pattern Y, 46%), lateral incisor placement mesial to the alveolar cleft (pattern X, 1.5%) and the presence of one tooth on each side of the alveolar cleft (pattern XY, 0.7%). The discrepancy between the distribution patterns of primary dentition and permanent dentition successors is 57.1%. Variations in tooth number in both primary and permanent dentition of UCLP patients occurred most often in the cleft area. Abnormalities in the number of teeth (hypodontia or hyperdontia) outside the cleft area were more common in the permanent dentition than in the primary dentition (24.1% versus 4.4%).

CONCLUSIONS

Four distribution patterns in the cleft area were identified in both sets of dentition. Our findings of distribution patterns in UCLP patients support the hypothesis that there may be two odontogenic origins for maxillary lateral incisors. Clinicians involved in managing the dentition of UCLP patients should consider the high frequency of numerical variation both in and outside the cleft area before starting dental treatment.

Validity of using fixation screws/wires as alternative landmarks for cephalometric evaluation after LeFort I osteotomy

The most widely used method to measure postoperative stability of a surgically repositioned bony segment is based on skeletal landmarks. Unfortunately, orthognathic surgery may alter the skeletal landmarks and bony configurations that are commonly used for cephalometric analysis. Intraosseous wires, plates, and screws are routinely used in orthognathic surgery, and postoperatively they are easier to identify than skeletal landmarks. Cephalometric radiographs from 25 adult patients, who had undergone LeFort I one piece osteotomy, were used to analyze the validity of fixation wires/screws used as landmarks to evaluate postoperative stability of the maxilla. The positional changes of maxillary skeletal landmarks (A point and anterior and posterior nasal spines) and intraosseous fixation wires/screws were measured relative to the cranial base. The fixation screws/wires were also measured relative to the invariant maxillary trabecular patterns and palatal plane from 1 to 6 weeks (T1-T2) and 6 weeks to 1 year postoperatively. The reproducibility of fixation wires/screws was found to be higher than that of skeletal landmarks. The fixation wires/screws remained stable in the maxilla; their postoperative positional changes were not significantly different from those of the skeletal landmarks. When the skeletal landmarks are altered or no longer exist after LeFort I osteotomy, fixation wires/screws could be used as alternative landmarks to measure the maxillary postoperative stability.

Content of reduced glutathione and consequences in recipients of glucose-6-phosphate dehydrogenase deficient red blood cells

The red blood cell glucose-6-phosphate dehydrogenase (G6PD) activity of every donor was examined with automatic enzyme-coupled method. The technique of molecular biology was applied to determine the DNA mutations for the 97 donors with undetectable G6PD activity. The concentration of reduced glutathione (GSH) in the stored RBC of the 97 G6PD-deficient donors and 124 normal donors was determined with the technique of high performance liquid chromatography. Routine blood counts, bilirubin and haptoglobin levels were used to evaluate posttransfusional hemolysis for the 48 adult patients transfused with 1 U G6PD deficient and 1 U normal RBC. Most (88, 90.7%) of the 97 donors were confirmed to be G6PD deficient at the DNA level. At each age interval of storage, the GSH concentration of G6PD-deficient RBC was significantly different from that of normal RBC. The total average value of GSH (pmol/gHb) was 2.52 +/- 0.95 (mean +/- 1 standard deviation) vs. 3.74 +/- 1.43 (P < 0.001). Hemoglobin, hematocrit, bilirubin, and haptoglobin levels in the patients receiving G6PD-deficient RBC were not statistically different from those in the recipients of normal RBC; even though the age of stored blood was 26-35 days. Within the same group of patients, the results of bilirubin and haptoglobin were not significantly changed before and after transfusion. The results of this study show that the GSH concentration in the stored blood of G6PD deficient donors was 67% of that in the normal donors. However, hemolysis does not occur in adult patients transfused with 1 U G6PD-deficient RBC. It seems unnecessary to screen G6PD activity for donors of adult recipients in Taiwan.

Plasticity of GAP-43 innervation of the spleen during immune response in the mouse. Evidence for axonal sprouting and redistribution of the nerve fibers

The amount and distribution of growth-associated protein (GAP-43)-like immunoreactive nerve fibers in the spleen of normal and immunized BALB/c mice were studied using immunohistochemical methods. A significant increase in the amount, as well as redistribution and morphological changes, of the GAP-43-like immunoreactive nerve fibers occurred in PPD (purified protein derivative from tuberculin) immunized animals. In the control animals, the GAP-43-like immunoreactive nerve fibers were found mainly distributed in association with vascular plexuses, with minor extension into the parenchyma of the inner zone of the periarterial lymph sheath. In the immunized animals, in addition to denser vascular plexuses, more fibers appeared in the outer zone of the periarterial lymph sheath, the marginal zone, and the red pulp, all known to be the sites where immune responding lymphocytes are located. Furthermore, the nerve fibers tended to have more branches and bear richer varicosities. The results suggest that active nerve remolding takes place in the spleen during immune response, which may serve as a mechanism through which the nervous system regulates immune responses.

Body size as a factor in different ages and breast cancer risk in Taiwan

A matched case-control study was done on 175 pathologically proven new cases of female breast cancer from National Taiwan University Hospital from February 1993 to June 1994 and 457 hospital controls individually matched for age and date of admission. Height and weight during one year before the first full-term pregnancy and one year before admission were collected from a questionnaire interview. Body mass index (BMI) (kg/m2) was derived accordingly. Demographic and reproductive characteristics, and family history of breast cancer were collected and adjusted as potential confounders. Conditional multiple logistic regression analysis was used to estimate the effect for each risk factor regarding body size of different ages. After adjustment for potential confounders, higher weight and BMI during one year before first full-term pregnancy were associated with a moderately lower risk of breast cancer especially in the premenopausal group. The heaviest group (> or = 65 kg) during one year before admission also had a moderately lower breast cancer risk. Height did not show any significant association with breast cancer risk. Weight and BMI gain were associated with an elevated breast cancer risk in the postmenopausal group but with wide confidence limits. The results of this study imply that adipose tissue may interfere with ovarian endocrine in the younger age group, and that there is increased hormonal production after obvious weight gain.

Two novel glucose 6-phosphate dehydrogenase deficiency mutations and association of such mutations with F8C/G6PD haplotype in Chinese

Glucose 6-phosphate dehydrogenase (G6PD) deficiency is a common genetic disease affecting 3% of the total Chinese population in Taiwan. To investigate the molecular basis of this deficiency, we analyzed blood samples from G6PD-deficient newborns using a nonradioactive polymerase chain reaction coupled with single-stranded conformation polymorphism (PCR-SSCP) analysis. We identified two novel G6PD mutations in Chinese. The first, G6PD Miaoli, involved a C-->G substitution at nucleotide (nt) 519, producing a Phe173 to Leu change in the protein. The second mutation (G6PD Keelung) involved a C-->T change at nt 1387, resulting in an Arg463 to Cys substitution. The F8C/G6PD (coagulation factor VIIIc) haplotype that spans the Xq28 region from the gene for coagulation factor VIIIc to the gene for G6PD was also investigated in Chinese using PCR and restriction enzyme digestion. Of the 16 possible haplotypes, only four were found, which suggests that these four polymorphic sites are in strong linkage disequilibrium. Analysis of the association of G6PD mutations with F8C/G6PD haplotype revealed that nt 517, 592, 835, and 1387 mutations are linked to haplotype VI+VII, whereas the nt 519 mutation is linked to haplotype III. The finding that some G6PD mutations are associated with a particular F8C/G6PD haplotype may be useful for future population studies.