Prosthetic patch durability in congenital diaphragmatic hernia: a long-term follow-up study

BACKGROUND/PURPOSE

The purpose of this study is to assess the durability of prosthetic patch repair of congenital diaphragmatic hernia (CDH) over time.

METHODS

The authors retrospectively reviewed the records of 109 children who had surgical repair of CDH between January 1989 and December 1996. Prosthetic patches were used for diaphragmatic agenesis or when the diaphragmatic defect was too large for primary closure after mobilizing the posterior leaf. Forty-five (41%) children required a prosthetic patch to repair the diaphragmatic defect, and 29 (64%) of these children survived.

RESULTS

Twelve (41%) of the 29 survivors required 1 or more operations for diaphragmatic reherniation. First-time reherniations occurred between 1 and 36 months postoperatively, median, 12 months. There was a bimodal distribution of first-time reherniations, with 4 children experiencing reherniation between 1 and 3 months, median age, 2 months and 8 children experiencing reherniation between 10 and 36 months, median age, 20 months. Three children returned for surgical repair of second reherniation between 21 and 39 months. Patients who had reherniation presented with bowel obstruction (n = 7), respiratory distress (n = 2), or were asymptomatic (n = 3). Revision of the reherniated patch consisted of placing an additional domed patch to fill the defect.

CONCLUSIONS

About half of all prosthetic patches used to repair CDH show evidence of reherniation and require revision within 3 years. Prosthetic patch repair is not a long-term solution for the child with CDH.

Measurement of the size and orientation of human masseter and medial pterygoid muscles

To gain a better understanding of biting and chewing performance, the size and orientation of the masseter and medial pterygoid muscles in living humans were studied. Twenty-seven young males having complete dentition, class I dental occlusion and normal muscle and jaw function were examined using magnetic resonance images of the head between the zygomatic arch and hyoid bone. The sections were parallel to the palatal plane, and the thickness was 3 mm without a gap. A computer software program (Medical Dental Image, MDI) was developed to identify and calculate the area of each cross section of the muscle, and the volume of the muscle was then estimated. The axis of the muscle was determined by connecting the centroids of the sections in the lower and upper 1/3 of the whole muscle. The effective muscle cross section area was then calculated by resectioning the muscle perpendicularly to the muscle axis. It was found that the mean masseter muscle volume was around 31 cm3, and that the mean medial pterygoid muscle volume was 11 cm3. Their mean effective cross section areas were around 6.2 cm2 and 3.5 cm2, respectively. The axis of the masseter muscle was more perpendicular to the palatal plane and parallel to the sagittal plane than was the medial pterygoid muscle. The results suggest that the use of magnetic resonance images (MRI) is an effective noninvasive measurement technique for determining the size and orientation of masseter and medial pterygoid muscles. This technique can be employed in future studies on human bite force evaluation and masticatory function.

Predicting soil-water partition coefficients for Hg(II) from soil properties

The metal adsorption characteristics for fifteen Taiwan soils by Hg(II), were evaluated using pH as the major variable. The soil samples were thoroughly characterized for their physical chemical properties and composition, particularly organic matter and metal oxides. The adsorption of Hg(II) increased with increasing pH between pH 2.5 and 5.5, whereas the adsorption significantly decreased above around pH 5.5. Below pH 5.5, greater adsorption was found for soils with a higher organic matter content at constant pH and metal concentration. To better understand the mechanism of adsorption, the experimental results for Hg (II) were tested in a partition coefficient model to relate the adsorption of the Hg(II) by the different soils with soil components: organic matter, iron oxide, aluminium oxide and manganese oxide. This model was not successful when applied to measurements at the differing natural soil pHs because of the importance of pH. At pH greater than 5.5 the model fails because of the complexation of Hg by the dissolved organic matter. However, partition coefficients obtained from experimental data were highly correlated with those calculated for a partition coefficient between mercury and organic matter alone at lower pH. Normalization of the partition coefficients, Kd, for the organic matter content of the soils, Kom, greatly improved the correlation between the partition coefficient and pH under pH 5.5 (R2 increased from 0.484 to 0.716). This suggests that the surficial adsorption sites are principally due to organic matter for pH less than 5.5. For the 24-hour equilibration period employed, diffusion of Hg through this superficial organic matter coating to underlying sorptive materials, including metal oxides, is not important in the partitioning of Hg. At pH above 5, a decrease of mercury adsorption with increasing solution pH was also found. This result may be explained in part by the complexation of mercury by soil dissolved organic matter whose concentration increased with increasing pH.

Monte Carlo simulations of polymer brushes

Three-dimensional Monte Carlo simulations of flexible and semiflexible polymer brushes at various grafting densities are carried out to study their equilibrium structure and attendant properties by using the bond fluctuation model. Our simulation results of long flexible polymer brushes are, in general, consistent with predictions of the self-consistent field theory. However, a depletion layer near the substrate is only observed at small grafting densities but not at medium densities. We have also measured the brush height and end-to-end distance of various polymer brushes, and their dependence on grafting density, chain length, and chain stiffness are obtained. The distribution of bending angles at various temperatures are calculated for four different forms of bending energy and our simulation results agree with theoretical predictions very well. Moreover, we study the isotropic-to-nematic transition of polymer brushes, which is found to be a continuous phase transition from our simulation results. Finally, we discuss the effects of local grafting density fluctuation on the monomer and end density distributions.

The effect of hydration on adsorption and desorption of heavy metals in soils

Cr, Ni, and Cd adsorption-desorption on five characterized Taiwan soils was studied. The potential for toxicity and the fate of metals in the soils is dependent upon the ability of the metals to desorb into the aqueous phase. To simulate field conditions, the soils were subjected to wet-dry cycles. The amount and rate of desorption was found to decrease with increasing number of cycles. The wet-dry cycle effect in the desorption of metals from soils is related to the soil composition, with desorption being easiest from sandy soil with low organic content. The desorption process is much slower than adsorption process. More than 95% of each metal adsorption takes place within one hour, and the amount of metal adsorbed from solution reached equilibrium in one day. In contrast, less than 20% metal desorption could be attained after 3 days each of four wet-dry cycles for Cr, Ni, and Cd.

CD34, CD117, and actin expression in phyllodes tumor of the breast

BACKGROUND

This study investigated the immunophenotypic patterns of CD34, CD117 (a product of the c-kit proto-oncogene), and actin (HHF35) in benign and malignant phyllodes tumors (PTs). We correlated the expression of CD34, CD117, and actin with histopathological grade.

MATERIALS AND RESULTS

We analyzed 19 cases (7 benign and 12 malignant cases) of PTs using immunohistochemical analysis. Six of 7 benign PT stromal lesions stained positively for CD34, while only 3 of 12 cases of malignant PT were focally CD34 positive (P = 0.0106). Only 1 of the 7 benign PTs stromal lesions expressed CD117. Nine of the malignant PTs were composed CD117-positive fibroblasts. This result demonstrated that CD117 expression is associated with the malignant potential of PTs (P = 0. 0106). Actin (HHF-35) expression was found in 8 of 12 cases of malignant PTs (P = 0.027), but in only 1 of 7 cases of benign PTs. Actin expression was significantly (P = 0.04) correlated to frequent mitotic activity (>5 mitoses per 10 high-power fields). The immunophenotypic markers were not related to tumor size. Additionally, we sequenced part of the juxtamembrane region of the c-kit proto-oncogene and found point mutations in two malignant PTs.

CONCLUSION

Our results demonstrated that expression of CD34 was associated with benign PTs, while CD117 and actin were preferentially expressed in malignant PTs. Our results implied that these immunohistological markers might be used for the histopathological grading of PTs.

Dilution wave and negative-order crystallization kinetics of chain molecules

We show that the crystal growth rate of a very long-chain n-alkane C C(198)H(398) from solution can decrease with increasing supersaturation and follow strongly negative order kinetics. The experimental behavior can be well represented by a theoretical model which allows the molecule to attach and detach as either extended or folded in two. The obstruction of extended-chain growth by unstable folded depositions increases disproportionately with increasing concentration. As a consequence of this abnormal kinetics, a "dilution wave" can propagate and trigger a folded-to-extended-chain transformation on its way.

Treatment of acute closed humeral shaft fractures with Ender nails

The effect of semirigid Ender nails (EN) in the treatment of closed humeral shaft fractures was reviewed and analyzed. Clinical study was set retrospectively with detailed parameters. One hundred and eighteen closed humeral shaft fractures, treated with closed reduction and internal fixation with ENs, were collected. The follow-up period was 78 (24-175) months. The average operation blood loss was 105 cc, operation time was 57 min, hospital stay was 6.5 days, and union time was 10.5 weeks. The postoperative complications included three superficial infections, one iatrogenic radial nerve palsy, eight nail backouts, and eight nonunions. In our experience, for closed humeral shaft fractures fixed surgically, EN is a good choice for its simplicity and efficacy, but the fracture gap should be minimized after fixation and postoperative care should be closely observed.

Growth hormone gene polymorphisms and growth performance traits in Duroc, Landrace and Tao-Yuan pigs

This study investigated the restriction fragment length polymorphism (RFLP) of the porcine growth hormone (pGH) gene in Duroc, Landrace, and Tao-Yuan pigs and its effects on growth performance and levels of plasma growth hormone in peripheral circulation. Genomic DNA extracted from 81 Tao-Yuan, 60 Landrace and 48 Duroc pigs were subjected to Southern blot hybridization with a pGH cDNA probe. Polymorphism was detected with the restriction enzymes TaqI and DraI. A comparison of these three breeds showed significant differences in allelic frequencies. Blood samples for radioimmunoassay (RIA) of GH were collected biweekly during the experimental period from pigs 12 to 40 weeks of age. Tao-Yuan pigs showed a mean plasma GH level (2.51 +/- 1.23 ng/mL) that was much lower than that of the Landrace (3.80 +/- 1.52 ng/mL) and Duroc (4.20 +/- 1.03 ng/mL) pigs (P < 0.05). Moreover, the Tao-Yuan pigs also showed poorer growth performance than the Landrace and the Duroc pigs both in the daily weight gain (0.37 +/- 0.06 vs. 0.67 +/- 0.05 and 0.70 +/- 0.05 kg/day, P < 0.01) and feed efficiency (3.12 +/- 0.28 vs. 2.60 +/- 0.14 and 2.52 +/- 0.12, P < 0.05). These results suggest that the growth performance trait in these pigs is highly correlated with their growth hormone genotype.

Locoregional recurrence in patients with one to three positive axillary nodes after mastectomy without adjuvant radiotherapy

PURPOSE

To retrospectively assess the risk of locoregional recurrence (LRR) and analyze the prognostic factors of this pattern of failure in patients with breast cancer and one to three positive axillary lymph nodes treated with modified radical mastectomy (MRM) without adjuvant radiotherapy.

METHODS

From April 1991 through December 1997, 649 patients received a diagnosis of invasive breast cancer, and 545 were treated with MRM. Eighty-one of these patients who were found to have one to three positive axillary nodes and had a minimum follow-up of 2 years were included in this study. None of the 81 patients received adjuvant radiation therapy after mastectomy; 43 patients received adjuvant chemotherapy; and 60 patients received adjuvant hormone therapy. The median duration of follow-up was 39 months.

RESULTS

Thirteen patients had LRR during follow-up, all within 2 years after mastectomy. The 3-year LRR rate was 14%. The 3-year rates of distant metastasis for patients with and without LRR were 48% and 14% (p = 0.03), respectively. The 3-year survival rates for patients with and without LRR were 73% and 87% (p = 0.01), respectively. In univariate analysis, age (p = 0.01), estrogen receptor (ER) status (p = 0.02), and the addition of hormone therapy (p < 0.001) were significant risk factors for LRR; in multivariate analysis, negative ER status (p = 0.02) was the only statistically significant risk factor. The 3-year LRR rates for ER-negative patients and those with positive or unknown ER status were 31% and 11%, respectively.

CONCLUSIONS

LRR after mastectomy is a substantial clinical problem, despite the use of adjuvant chemotherapy and/or hormone therapy. Further randomized trials of postmastectomy radiotherapy for patients with one to three positive axillary nodes and specific risk factors are urgently needed to determine its potential benefit in locoregional control and survival, especially for young and ER-negative patients.

An adaptive snake model for ultrasound image segmentation: modified trimmed mean filter, ramp integration and adaptive weighting parameters

The snake model is a widely-used approach to finding the boundary of the object of interest in an ultrasound image. However, due to the speckles, the weak edges and the tissue-related textures in an ultrasound image, conventional snake models usually cannot obtain the desired boundary satisfactorily. In this paper, we propose a new adaptive snake model for ultrasound image segmentation. The proposed snake model is composed of three major techniques, namely, the modified trimmed mean (MTM) filtering, ramp integration and adaptive weighting parameters. With the advantages of the mean and median filters, the MTM filter is employed to alleviate the speckle interference in the segmentation process. The weak edge enhancement by ramp integration attempts to capture the slowly varying edges, which are hard to capture by conventional snake models. The adaptive weighting parameter allows weighting of each energy term to change adaptively during the deformation process. The proposed snake model has been verified on the phantom and clinical ultrasound images. The experimental results showed that the proposed snake model achieves a reasonable performance with an initial contour placed 10 to 20 pixels away from the desired boundary. The mean minimal distances from the derived boundary to the desired boundary have been shown to be less than 3.5 (for CNR > or = 0.5) and 2.5 pixels, respectively, for the phantom and ultrasound images.

Growth enhancement of fowls by dietary administration of recombinant yeast cultures containing enriched growth hormone

In present study the methylotrophic yeast, Pichia pastoris, was used to express a recombinant growth hormone (rGH) gene of swine. A synthetic secretion cassette was constructed using the promoter of the alcohol oxidase1 gene (AOX1), and a alpha-factor signal peptide. After electroporatic transformation and zeocin selection, several clones exhibited high levels of rGH protein expression constituting more than 20% of total yeast protein. Over 95% of rGH was shown to be export into the culture supernatant. Yeast transformant containing the highest recombinant growth hormone level (rGH yeast) and native GS115 Pichia pastoris (non-rGH yeast, as a control) were separately cultured, harvested and adsorbed by wheat bran. Yeast cultures of four dosages (0.05, 0.1, 0.2, and 0.4%) were mixed respectively with chick basal diet and fed to simulated country chickens for 9 weeks. The results showed that, when compared to control chicks, the percentage of body weight gain was improved significantly (P<0.05) in chicks fed with diets containing 0.1 or 0.2% rGH-rich yeast culture at brooding stage, and in chicks fed with 0.4% rGH-rich yeast culture at growing stage. The average weight gain in rGH yeast treated groups for the full-term (0 to 63d) and short term (43 to 63d) of growth were 10.6 and 9.4%, respectively, better than the non-rGH yeast control group. These experimental data suggest that the use of rGH-containing yeast as a supplement in fed provided an alternative approach for growth improvement in simulated country chickens.

Lung toxicity of paraquat in the rat

In a rat model of paraquat-induced lung injury, pulmonary alveolar lavage fluid metabolic parameters were assessed to establish damage, and the use of surfactant was employed as a protective agent. Three groups of adult male Sprague-Dawley rats received intraperitoneal injection of paraquat (35 mg/kg body weight) in 1 ml saline, or received 1 ml saline, or no material. On d 3, 7, 14, and 21 after injection, pressure-volume curves and pulmonary alveolar lavage fluids were obtained. On d 3 paraquat significantly increased the lung wet/dry weight ratio and protein content but lowered phosphatidylcholine levels. There were no marked changes at other time points in the parameters examined. The pressure-volume curves initially moved downward and to the right on d 3 and 7 and then returned to control levels in the paraquat-treated rats. Immediate intratracheal administration of Survanta after paraquat injection (70 mg/kg body weight) tended to increase the survival rate on d 1 compared to rats without Survanta administration. Our results suggest that administration of exogenous surfactant may play a role in the treatment of patients poisoned with paraquat.

Thymus size and its relationship to perinatal events

A retrospective study was conducted to assess radiographically the thymus size in well and sick neonates and to search for a possible relationship to perinatal events. Thymus size was expressed as cardiothymic:thoracic ratio (CT/T) by measuring the width of the cardiothymic shadow at the level of carina and dividing it by the width of the thorax at the costophrenic angles. The CT/T was measured on chest radiographs obtained on day 1 in well term neonates consecutively born in our nursery and sick neonates with meconium staining of the amniotic fluid, meconium aspiration syndrome or respiratory distress syndrome (RDS). Neonates with congenital anomalies, congenital heart disease or intrauterine growth retardation were excluded. There were no significant relationships between CT/T and sex, birth route, birthweight or gestational age in well and sick term neonates. The CT/T were comparable among well and sick term neonates and were significantly greater in the preterm neonates with RDS than in the preterm neonates without RDS. The CT/T was correlated to the birth route only in the preterm neonates. We conclude that thymus involution in the perinatal period is a complex process and the response is different between term and preterm neonates.

Anti-aging effects of the traditional Chinese medicine bu-zhong-yi-qi-tang in mice

Among the "alternative medicines," which may ably supplement modern Western medicine in the treatment of certain diseases, the holistic approach and mild nature of the majority of Traditional Chinese Medicine (TCM) may make it particularly suitable for the treatment of diseases associated with old age, as the general health of elderly patients is already compromised. The TCM formulation of bu-zhong-yi-qi-tang (B.Z.Y.Q.T.), prescribed mainly for the improvement of circulation and in particular that to the gastroenteric regions, may have anti-aging effects. In the present study, possible anti-aging effects of B.Z.Y.Q.T. were studied using normal (ICR) mice and the Dull, P/8 and R/1 strains of the Senescence Accelerated Mouse (S.A.M.). Following repeated oral administrations of B.Z.Y.Q.T. at 250 and 500 mg/kg the test mice were assessed for (1) endurance (2) learning and memory (3) neuromuscular coordination and (4) changes in the levels of monoamines in the brain. The results indicated that B.Z.Y.Q.T. improved endurance in all strains in a dose-dependent manner. At the higher dose of 500 mg/kg, it improved memory in the R/1 and P/8 S.A.M. mice. In prolonged rota-rod tests, which assessed both motor coordination and endurance, B.Z.Y.Q.T. significantly improved performance in the P/8 S.A.M. mice. Elevated dopamine and noradrenaline were observed in cortical tissues of the S.A.M./Dull and ICR mice respectively with the high dose of 500 mg/Kg, B.Z.Y.Q.T. Taken together, the results indicated that B.Z.Y.Q.T. appeared to exert anti-aging effects in mice and elevation in certain monoamines in brain cortical tissues. How and whether the monoamines changes after B.Z.Y.Q.T. treatment might be related to the behavioral effects await further investigation.

Bioequivalence study of tramadol by intramuscular administration in healthy volunteers

Tramadol hydrochloride (CAS 36282-47-0) is a centrally acting analgesic agent binding to mu opiate receptors. The bioavailability of a new tramadol hydrochloride injection (Limadol) was compared with a commercially available reference product by intramuscular administration in twelve healthy Chinese male volunteers by a standard two-way cross-over trial. Each volunteer received a single 100 mg injection of tramadol HCl in each phase. The bioavailability was compared using the area under the plasma concentration-time curve from time 0 to 30 h (AUC0-30), the area under the plasma concentration-time curve from time 0 to infinity (AUC0-infinity), peak plasma concentration (Cmax), and time to reach peak plasma concentration (Tmax). No statistically significant difference was observed between the Tmax, Cmax, AUC0-30 and AUC0-infinity of the two preparations. It is concluded that test and reference formulations of tramadol hydrochloride are bioequivalent for both the extent and rate of absorption after a single intramuscular injection.

[Stereotactic conformal radiotherapy technology]

Body Stereotactic Conformal Radiotherapy technology was introduced in this paper. This discusses target localization, beam shape, treatment planning system and reproducibility.

Molecular epidemiological studies on foot-and-mouth disease type O Taiwan viruses from the 1997 epidemic

Sequence diversity was assessed of the complete VP1 gene directly amplified from 49 clinical specimens during an explosive foot-and-mouth disease (FMD) outbreak in Taiwan. Type O Taiwan FMD viruses are genetically highly homogenous, as seen by the minute divergence of 0.2-0.9% revealed in 20 variants. The O/HCP-0314/TW/97 and O/TCP-022/TW/97 viral variants dominated FMD outbreaks and were prevalent in most affected pig-raising areas. Comparison of deduced amino acid sequences around the main neutralizable antigenic sites on the VP1 polypeptide showed no significant antigenic variation. However, the O/CHP-158/TW/97 variant had an alternative critical residue at position 43 in antigenic site 3, which may be due to selective pressure in the field. Two vaccine production strains (O1/Manisa/Turkey/69 and O1/Campos/Brazil/71) probably provide partial heterologous protection of swine against O Taiwan viruses. The type O Taiwan variants clustered in sublineage A1 of four main lineages in the phylogenetic tree. The O/Hong Kong/9/94 and O/1685/Moscow/Russia/95 viruses in sublineage A2 are closely related to the O Taiwan variants. The causative agent for the 1997 epidemic presumably originated from a single common source of type O FMD viruses prevalent in neighboring areas.

Treatment of acetabular fractures: 10-year experience

BACKGROUND

Acetabular fracture is a controversial and difficult fracture to manage. We retrospectively evaluated the outcome of the traditional management of acetabular fractures.

METHODS

From 1987 to 1996, 112 cases of acetabular fracture presented at the Taipei Veterans General Hospital and were managed surgically in 73 cases and nonsurgically in 39 cases. The follow-up period was 90 (36-140) months.

RESULTS

In the nonsurgically managed group, congruent reduction was achieved in 29 cases (74.3%) and good to excellent functional results were achieved in 25 cases (64.1%). In the surgically managed group, congruent reduction was achieved in 60 cases (82.2%) and good to excellent functional results were achieved in 57 cases (74.3%). In 51 (45.5%) cases, early or late complications developed after management, including one femoral artery perforation, one screw penetration, three wound infections, one iatrogenic sciatic nerve injury, one deep vein thrombosis, 21 heterotopic ossifications, two chondrolyses, three avascular necroses of the femoral head and 18 cases of symptomatic traumatic arthritis.

CONCLUSIONS

The functional results correlated well with the final congruity of the joints and the severity of the complications.

Surgical treatment of displaced acetabular fractures - 72 cases followed for 10 (6-14) years

Seventy-two displaced acetabular fractures managed surgically were evaluated retrospectively. The follow-up period was 10 (6-14) yr. The commonest fractures were posterior wall (28) and both columns (10). The surgical approaches were Kocher-Langenbeck (47), ilioinguinal (19) and extended iliofemoral (6). No neural monitoring was used in operations and no preventive agents for heterotopic ossification or thromboembolism were used perioperatively. Reduction was rated congruent in 59 (81.9%) and noncongruent in 13 (18.1%). The early postoperative complications were 1 vascular injury, 1 iatrogenic sciatic nerve injury, 1 deep vein thrombosis and 2 wound infections. The late complications were heterotopic ossification in 20 patients, avascular necrosis of the femoral head in 4 and symptomatic arthritis in 10. Functional outcomes were rated as excellent in 31, good in 23, fair in 7 and poor in 11. Our results show that traditional management is effective enough for displaced acetabular fractures.

Ipsilateral hip and distal femoral fractures

We tried to find the trauma mechanism and treatment rationale of ipsilateral concomitant hip and distal femoral fractures involving the articular surface. Between 1988 and 1995, 15 cases of ipsilateral hip (confined to neck or trochanteric areas of the femur) and distal (confined to supra- and intercondylar area of the femur) femoral articular fractures were collected. The hip fractures consisted of 10 trochanteric fractures and five neck fractures, which were managed with reduction and fixation in 14 (Knowles' pin in eight, DHS in four and standard Gamma nail in two), and primary bipolar hemiarthroplastry in one. The distal femoral articular fractures were open in 11; these were managed with radical debridement, implantation of Septopal chains and immediate internal fixation, followed by prophylactic autogenous bone grafting 6 weeks later in the recent six cases (five Judet plates, four dynamic condylar screws and two condylar plates). The other four closed distal femoral fractures were managed with early reduction and internal fixation (two Judet plate, one dynamic condylar screw and one condylar plate). The union time was 20.3 (12-48) weeks for proximal fractures and 23.7 (12-36) weeks for distal fractures. Early infection developed in three cases. Nonunion of a femoral neck fracture developed in one case. The other complications were implant failure in one, coxa vara in one, refracture in one, delayed union in one and knee stiffness in one.

Adjuvant sequential chemotherapy with doxorubicin plus cyclophosphamide, methotrexate, and fluorouracil (ACMF) with concurrent radiotherapy in resectable advanced breast cancer

Doxorubicin (Adriamycin) is an anthracycline effective in breast cancer. Despite a worldwide acceptance of Adriamycin in the adjuvant chemotherapy to maximize the survival benefit in the higher risk patients with breast cancer with promising results, oncologists in general do not favorably consider anthracyclines in the adjuvant treatment setting because of concern about the acute and chronic drug-related toxicity. For high-risk patients with breast cancer with more than three positive axillary lymph nodes, this series adopted a modified sequential regimen of ACMF first with Adriamycin (A) as a single agent in 3-weekly administration for three courses, and then a combination of cyclophosphamide, methotrexate, fluorouracil (CMF) every 3 to 4 weeks for six courses given in an outpatient setting concurrent with radiation therapy as an adjuvant treatment. A total of 56 patients underwent modified radical mastectomy and 3 others breast conservation surgery for their invasive breast cancer. Forty-seven (84%) patients completed the intended adjuvant treatment and 1 patient died of infection from treatment-related neutropenia. As a whole, the 3-year overall survival and disease-free survival rates of 56 patients analyzed were 82.3% and 64.4%, respectively. In this high-risk group, patients with four to nine positive nodes showed a slightly better trend of survival than those with 10 or more positive nodes without reaching statistically significant difference (36-month overall survival: 90.9% vs. 72.5%, p = 0.06; disease-free survival: 78.7% vs. 47.8%, p = 0.38). In this entire group of patients, locoregional recurrence was absent. A total of 55 episodes of grade III and IV hematologic toxicity were observed, with only one death from neutropenic sepsis. This modified ACMF regimen offers a good survival rate in breast cancer patients with more than three positive axillary lymph nodes. When these patients are carefully managed, the morbidity and mortality related to the treatment are low.

Clinical and epidemiological implications of swine hepatitis E virus infection

In nonendemic areas, most patients with acute hepatitis E were infected through traveling to endemic areas. However, some patients did not have a history of foreign travel before infection. Furthermore, high seroprevalence rates of antibody to hepatitis E virus (anti-HEV) were found in the general adult population in some countries without any recorded outbreak of hepatitis E. The significance of anti-HEV assay in these subjects remains obscure. To study if swine might be a source of HEV infection, HEV was tested in sera of 235 pigs in Taiwan, and from 5 patients with acute HEV infection who either denied or did not provide any foreign travel history. Three (1.3%) pigs had detectable swine HEV RNA. The swine and human HEV strains from Taiwan formed a monophyletic group, distinct from three previously reported groups: the United States human and swine HEV strains, the Mexico strain, and the largest group composed of the Asian and the African strains. The identity of nucleotide sequences was 84-95% between swine and human HEV strains in Taiwan, and 72-79% between Taiwan strains and those from different areas. The predicted amino acid sequence of a Taiwan swine HEV strain within the peptide 3-2 used in commercial anti-HEV assay showed a high identity (91-94%) with those of other human and swine HEV strains. Swine may be a reservoir of HEV and subclinical swine HEV infection may occur. Cross-reactivity of current anti-HEV assay may account for the high prevalence rate of anti-HEV in the general population in nonendemic areas.

The effect of posterior capsulorrhaphy in primary total hip arthroplasty: a prospective randomized study

Between 1994 and 1997, 180 cases of primary total hip arthroplasty (THA) were performed with the posterior (Moore) approach for a variety of indications and studies prospectively. The cases were separated randomly into 2 groups to evaluate the effect of posterior capsulorrhaphy in the prevention of postoperative dislocation. In group 1 (96 cases), closure of the arthroplasty was performed with a posterior capsulorrhaphy; in group 2 (84 cases), closure was performed without capsulorrhaphy. The follow-up period was 38 months (range, 12-60 months). No dislocations occurred in group 1, whereas 2 dislocations (2.3%) occurred in group 2. Although the factors affecting dislocation in primary THA are many, a posterior capsulorrhaphy may be helpful in the prevention of posterior dislocation of primary THA performed with a posterior approach.