Neonatal Duhamel's pull-through for Hirschsprung's disease

BACKGROUND

Neonatal Duhamel's pull-through was compared with 2 other approaches to Hirschsprung's disease (HD) diagnosed in the neonatal period.

METHODS

Fifty HD patients, undergoing Duhamel's pull-through, were divided into 3 groups. Group I had 14 patients with neonatal pull-through; group II had 9 patients with delayed one-stage pull-through; and group III had 27 patients with two-stage pull-through. Operative bleeding and time, complications, and functional results were analyzed.

RESULTS

The operative bleeding and operative time were significantly more and longer in group III (p < 0.001). Post-operative enterocolitis and fecaloma occurred in 9 (18%) and 16 (32%) patients respectively, and neither of the complications were different among 3 groups (p = 0.826 and 0.868). The common wall of the rectal pouch in group I was eliminated by endo-GIA stapler in 11 patients, and clamp placement in 3. Of 4 patients of group I with fecaloma, only I used endo-GIA stapler. The functional results were good in 35 patients, with mild constipation in 15 and were not statistically different among 3 groups (p = 0.184).

CONCLUSIONS

HD on neonates can be successfully treated by Duhamel's pull-through in neonatal period using endo-GIA stapler. The functional results are as good as those with the delayed one-stage or two-stage Duhamel's procedure, with the child usually benefitting by not having home enema or stoma.

Impalpable cryptorchidism--a review of 170 testes

BACKGROUND

The diagnosis and treatment of cryptorchidism are continuously straightforward except impalpable testis. Preoperative diagnosis and surgical plans of impalpable testis are controversial. In this study, we evaluated our results of treating patients with impalpable testes.

METHODS

One hundred and fifty patients with 170 impalpable testes are retrospectively reviewed. The preoperative diagnostic modalities, preoperative localization, operative findings and methods and operative results are analyzed. The operated testes are evaluated and followed for at least 6 months after operation.

RESULTS

Preoperative localization could be achieved in 120 testes (70.6%) by image studies (111 by ultrasound, 6 by computed tomography and 3 by magnetic resonance image) and was completely compatible with operative localization. Operative localization for the other 50 testes was done by exploration with laparoscopic assistance in 25. Vanished testis or testicular remnant was noted in 37 testes (21.8%) and the locations of viable testes were prescrotal in 24 (14.1%), canalicular in 86 (50.6%) and abdominal in 23 (13.5%). Preoperative ultrasound could find 96.3% (106/110) of viable testes located in prescrotal and canalicular area, but only 21.7% (5/23) in abdomen. Laparoscopic assistance is very useful of localizing intraabdominal testes and confirming vanished testes. Orchiopexy was done in 126 viable testes (94.7%) by one-stage in 120 testes and two-stage in 6. Post-operative testicular atrophy was noted in 6 testes.

CONCLUSIONS

Most of the impalpable viable testes located in prescrotal and canalicular could be detected by ultrasound. Laparoscopic examination can avoid unnecessary exploration. Excluding vanishing and severe atrophic testes, about 90% of impalpable testes can be saved with orchiopexy, mostly by one-stage operation.

[Study on the interaction between sparfloxacin and serum albumins by fluorescence]

The binding reaction between sparfloxacion (SPFX) and bovine serum albumin (BSA) or chicken egg albumin (CEA) in aqueous was studied using fluorescence and absorption spectra. Their binding constants are KCEA = 8.29 x 10(6) and KBSA = 4.41 x 10(7), and the binding sites are nCEA = 0.558, nBSA = 0.793 respectively. The action distances (RCEA = 1.99 nm, RBSA = 2.09 nm) and energy transfer efficiencies (ECEA = 0.766, EBSA = 0.714) between donor-acceptor and SPFX were obtained by Förster's nonradiative energy transfer mechanism. The experiment demonstrated that the higher the temperature is, the lower the slopes of quenching curves of BSA and CEA are in presence of different amounts of SPFX. It is confirmed that the combination for SPFX with BSA or CEA is a single static quenching process, their interaction may be interpreted with energy transfer mechanism. Through binding reaction of the two albumins with SPFX, the biological effects and action mechanism of SPFX with albumins in vivo were discussed.

Corneal decompensation and graft failure secondary to a broken posterior chamber poly(methyl methacrylate) intraocular lens haptic

A 66-year-old man developed an unexplained corneal decompensation 7 years after extracapsular cataract extraction and implantation of a single-piece poly(methyl methacrylate) (PMMA) posterior chamber intraocular lens (IOL). He had penetrating keratoplasty (PKP). Two years later, he developed corneal graft failure secondary to an IOL haptic fragment in the anterior chamber angle. The patient had a repeat corneal graft and IOL exchange. The broken haptic was examined with scanning electron microscopy. The findings were consistent with late fracture of the haptic within the capsular bag, which was presumably weakened by an improper implantation technique. Fracture of a PMMA haptic should be suspected as a cause of corneal decompensation and corneal graft failure after cataract surgery. This case emphasizes the importance of safe implantation techniques.

Functional magnetic resonance imaging of the visual system

Functional magnetic resonance imaging (fMRI), which is a technique useful for non-invasive mapping of brain function, is well suited for studying the visual system. This review highlights current clinical applications and research studies involving patients with visual deficits. Relevant reports regarding the investigation of the brain's role in visual processing and some newer fMRI techniques are also reviewed. Functional magnetic resonance imaging has been used for presurgical mapping of visual cortex in patients with brain lesions and for studying patients with amblyopia, optic neuritis, and residual vision in homonymous hemianopia. Retinotopic borders, motion processing, and visual attention have been the topics of several fMRI studies. These reports suggest that fMRI can be useful in clinical and research studies in patients with visual deficits.

[Study on high-efficiency gene transfer of pseudotyped HIV vector]

OBJECTIVE

To investigate the high-efficiency of pseudotyped HIV as gene transfer vector.

METHODS

Three plasmids of pseudotyped HIV gene transfer vector system were transferred into packaging cell line 293T by Ca3 (PO4)2 precipitation method. GFP (Green Fluorescence Protein) or HSV-tk gene was constructed in the plasmid pHR'CS respectively (pHR'CS.GFP or pHR'CS.HSV-tk). The pseudotyped HIV particles were observed through electronic microscopy and were measured through spectrofluorophotometer. High titer pseudotyped HIV was harvested from volume of virus-producing cell supernatant and concentrated. Ovarian epithelial cancer cell line SKOV3 and normal human gingival fibroblast cell GF were infected by pseudotyped HIV. PCR and RT-PCR were resorted to demonstrate the successful transduction and transcription of the HSV-tk gene. After administration of GCV, the changes of those cells and apoptosis were observed through optical microscopy. The cytotoxicity efficacy of HSV-tk/GCV system was evaluated by MTT method. The growth inhibition rate (GIR) of cells and inhibition concentration 50 (IC50) were counted.

RESULTS

The above plasmids were effectively transferred into 293T cell. A lot of pseudotyped HIV particles were observed through electronic microscopy. The virus supernatant had a high absorbing value at 510 nm through spectrofluorophotometer, which proved the existence of virus. After pseudotyped HIV infection, SKOV3 and GF had remarkable infection rate. 600 bp strand was seen through PCR and RT-PCR. Changes and apoptosis of cells followed by administration of GCV were observed. The MTT method showed that the cytotoxicity efficacy of GCV was high to SKOV3 and GF cell.

CONCLUSIONS

The pseudotyped HIV is a high-efficiency gene transfer vector.

Effect of genotoxic exposure to chromium among electroplating workers in Taiwan

The objective of this study was to investigate the association between chromium (Cr) concentrations and sister chromatid exchanges (SCE) formation in Cr workers and to assess the effects of susceptible genes (glutathione S-transferase M1 and T1) on the frequency of deletion and SCE/cell. Urinary Cr concentration was significantly elevated in Cr workers (3.67 +/- 3.89 microg/g creatinine) compared to control group (1.21 +/- 1.16 microg/g creatinine, P < 0.01). There was also a significant difference of superoxide dismutase (SOD) levels between Cr workers (6.86 +/- 0.80 U/mg Hb) and controls (7.16 +/- 0.53 U/mg Hb, P < 0.01). The frequencies of SCE and high frequency cells (HFC) were significantly correlated with smoking habits and with duration of exposure to Cr. A significantly higher percentage (50%) of Cr workers had both the null GSTM1 and GSTT1 genotype as compared to 10% of the controls (P < 0.01). However, the chromosomal DNA damage effect of GSTM1 and GSTT1 genotypes, individually or in combination, was not revealed in Cr exposed workers.

Distribution of enantiomers of trans-tramadol and trans-O-demethyltramadol in central nervous system of rats

AIM

To investigate the distribution of the enantiomers of trans-tramadol (trans-T) and its active metabolite, trans-O-demethyltramadol (M1), in the central nervous system (CNS).

METHODS

After a single ip dose of trans-T hydrochloride or M1, the rats were killed by decapitation. A high performance capillary electrophoresis (HPCE) method was used to determine the concentrations of enantiomers of trans-T and M1 in the serum and different brain tissues, including cerebrospinal fluid (CF), cerebral cortex (CC), corpus striatum (CS), hypothalamus (HY), cerebellum (CE), and medulla oblongata (MO).

RESULTS

After ip trans-T hydrochloride, the concentrations of (+)-trans-T were higher than those of (-)-trans-T in the serum and all tested brain tissues; The concentrations of (+)-M1 were lower than those of (-)-M1 in the all tested brain tissues; The concentrations of the enantiomers of trans-T and M1 were the highest in the CC, the lowest in the CF. After ip M1, the concentrations of (+)-M1 were higher than those of (-)-M1 in the serum and all tested brain tissues; The concentrations of the enantiomers of M1 were the highest in the CC, the lowest in the CF.

CONCLUSION

The concentrations of the enantiomers of trans-T and M1 varied in the serum and different brain tissues. The distribution of trans-T and M1 in the CNS of rats was stereoselective. The stereoselectivity in the distribution of M1 after M1 injection was different with that after trans-T injection.

Functional magnetic resonance imaging of eye dominance at 4 tesla

We studied eye dominance in visual cortex and lateral geniculate nucleus (LGN) using functional magnetic resonance imaging (fMRI) at a very high magnetic field (4 tesla). Eight normal volunteers were studied with fMRI at 4 tesla during alternating monocular visual stimulation. The acquisition was repeated twice in 4 subjects to confirm reproducibility. In addition, magnetic resonance signal intensities during three conditions (right eye stimulation, left eye stimulation, and control condition) were compared to determine whether the observed area was truly or relatively monocular in 2 subjects. In both the individual and group analyses, the anterior striate cortex was consistently activated by the contralateral eye more than the ipsilateral eye. Additionally, we found evidence that there were areas in the bilateral LGN which were more active during the stimulation of the contralateral eye than during the stimulation of the ipsilateral eye. The activated areas were reproducible, and the mean ratio of the overlapping area was 0.71 for the repeated scans. The additional experiment revealed that the area in the anterior visual cortex could be divided into two parts, one truly monocular and the other relatively monocular. Our finding confirmed previous fMRI results at 1.5 tesla showing that eye dominance was observed in the contralateral anterior visual cortex. However, the eye dominance in the visual cortex was found not only in the most anterior area corresponding to the monocular temporal crescent but also in the more posterior area, presumably showing the greater sensitivity of the temporal visual field (nasal retina) as compared with the nasal visual field (temporal retina) in the peripheral visual field (peripheral retina). In addition, it is suggested that the nasotemporal asymmetry of the retina and the visual fields is represented in the LGN as well as in the visual cortex.

Hepatic Schistosomiasis japonica in a patient with gallstones and bile duct stones--a case report

Schistosomiasis, a common parasitic disease in many countries, is found as imported cases in Taiwan. Responsible for human infections are five species, one of which, Schistosoma japonicum, is currently endemic in China and South-east Asia. Chronic infection with S. japonicum may lead to the development of liver fibrosis, calcification and portal hypertension. Under investigation by sonography and computed tomography (CT) scan, a peculiar "turtle-back" appearance of liver fibrosis and calcification may be found. Herein, we report a case referred to our department due to jaundice. The sonography of liver showed typical "turtle-back" appearance. Gallstones and bile duct stones were also found in this case. Surgical interventions with percutaneous transhepatic biliary drainage (PTBD), cholecystectomy and choledocholithotomy were performed to relieve the obstructive jaundice and remove the stones. There were no parasitic eggs in the extracted stones or in drained bile juice. However, deposits of calcified S. japonicum eggs in liver parenchyma and portal tracts were identified in liver biopsy. No special treatment was given for the schistosomiasis japonica because the calcified parasitic eggs were the sequelae of past infection.

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.