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Chen CH, Lee PS, Han WJ, Shen KH. Primary giant cell malignant fibrous histiocytoma of the kidney with staghorn calculi. J Postgrad Med 2003; 49:246-8. [PMID: 14597788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Malignant fibrous histiocytomas (MFH) as primary renal tumours are rare, with less than 50 cases described in the literature. We report a case of primary renal MFH of giant cell type in a 56-year-old man, who presented with bilateral dull flank pain, intermittent gross haematuria and body weight loss (6 kg in 3 months). Intravenous urography, computerized tomography (CT) and magnetic resonance image (MRI) showed right ureteral stones with mild hydronephrosis, and a solid mass at the lower pole of the left kidney associated with staghorn calculi, as well as tumour thrombi in the left renal vein and inferior vena cava. Left radical nephrectomy and evacuation of tumour thrombi from the left renal vein and inferior vena cava were performed. Histopathologic examination revealed malignant fibrous histiocytoma (MFH) of giant cell type. To the best of our knowledge, this is the first report of primary renal MFH associated with staghorn calculi.
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Affiliation(s)
- C H Chen
- Division of Urology, Department of Surgery, Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
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Shen KH, Lush SF, Chen TL, Liu RS. Synthesis of bicyclic pyrane derivatives via tungsten-mediated [3 + 3] cycloaddition of epoxides with tethered alkynes. J Org Chem 2001; 66:8106-11. [PMID: 11722212 DOI: 10.1021/jo010698e] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Propargyltungsten compounds bearing a tethered epoxide were prepared in short steps from readily available materials. In the presence of various Lewis acids, BF(3).Et(2)O catalysts (25 mol %) most effectively promote the [3 + 3] cycloaddition of the epoxide with its tethered propargyltungsten group, delivering bicyclic pyranyltungsten compounds in reasonable yields. This cyclization proceeds highly diastereoselectively with tolerance of various functional groups. The stereochemical outcome indicates that the cycloaddition is initiated by the ring opening of the epoxides via an exo-attack of the propargyltungsten group. The resulting pyranyltungsten organometallics were demetalated to yield various bicyclic pyranyl derivatives using different oxidants. This new method provides a short enantiospecific synthesis of bicyclic oxygen compounds if chiral epoxide is used in the cyclization. A mechanistic model is presented to rationalize the reaction pathway of this [3 + 3] cycloaddition.
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Affiliation(s)
- K H Shen
- Department of Chemistry, National Tsing-Hua University, Hsinchu, 30043 Taiwan
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Madhushaw RJ, Li CL, Shen KH, Hu CC, Liu RS. Tungsten-promoted [3 + 2]- and [3 + 3]-cycloaddition of epoxides with alkynes. A facile enantiospecific synthesis of bicyclic lactones. J Am Chem Soc 2001; 123:7427-8. [PMID: 11472176 DOI: 10.1021/ja0106016] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R J Madhushaw
- Department of Chemistry, National Tsing-Hua University Hsinchu, Taiwan, ROC
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Wu CW, Hsieh MC, Lo SS, Shen KH, Lui WY, P'eng FK. Comparison of the UICC/AJCC 1992 and 1997 pN categories for gastric cancer patients after surgery. Hepatogastroenterology 2001; 48:279-84. [PMID: 11268985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND/AIMS UICC/AJCC 1997 classification changes pN category. We evaluated its prognostic impact. METHODOLOGY A total of 710 patients who underwent a > or = D2 gastrectomy were recruited. Among them, the data of 319 patients who had involved regional lymph nodes and no evidence of distant metastases were used for comparing the 1992 and 1997 pN categories. RESULTS For 1997 category, 201 patients (64%) were pN1, 75 (23.5%) pN2, and 43 (13.5%) pN3. For 1992 category, 143 patients (44.8%) were pN1, and 147(46.1%) pN2. 29 patients (9.1%) with lymph node metastasis to the hepatoduodenal ligament were distant metastasis. The 1997 pN category was a more powerful prognostic discriminant (relative risk: 2.086) than the 1992 category. Compared to the 1992 stage classification, the 1997 one had a skewed distribution of patients with marked shift of patients of stage IIIA (105-126 patients), IIIB (116-58 patients), and IV (100-122 patients). The survival difference between stage IIIA and IIIB for the 1997 stage classification is narrower than for 1992. CONCLUSIONS The 1997 pN category allows for estimation of prognosis superior to the 1992 category.
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Affiliation(s)
- C W Wu
- Department of Surgery, Veterans General Hospital-Taipei, Shih-Pai Road, Taipei, Taiwan, 11217, Republic of China.
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Lo SS, Wu CW, Chi KH, Tseng HS, Shen KH, Hsieh MC, Lui WY. Concomitant chemoradiation treatment in the management of patients with extrahepatic biliary tract recurrence of gastric carcinoma. Cancer 2000; 89:29-34. [PMID: 10896997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND The aim of this study was to determine the role of concomitant chemoradiation in the alleviation of obstructive jaundice in patients with extrahepatic biliary tract metastases from gastric carcinoma. METHODS Thirteen patients with good performance status who had obstructive jaundice resulting from extrahepatic biliary metastases after gastrectomy for gastric carcinoma were treated with palliative intent. Treatment consisted of insertion of a percutaneous transhepatic choledochal drainage (PTCD) catheter followed by external radiation up to a total dose of 40-60 grays in combination with chemotherapy (cisplatin 20 mg/m(2)/day, 5-fluorouracil 600 mg/m(2)/day, and leucovorin 90 mg/m(2)/day for 96 hours during the first and fifth weeks) on an outpatient basis. RESULTS The concomitant chemoradiation produced a good palliative effect in all 13 patients. Hyperbilirubinemia continued to improve after treatment, patients' clay-colored stool resolved within an average of 4 weeks (range, 2-6 weeks), and bilirubin levels returned to normal. The PTCD catheter could be removed after treatment was completed (the seventh week); the mean duration of PTCD placement was 2 months. The entire treatment course was performed on an outpatient basis; hospital admission was necessary only for PTCD insertion and chemotherapy. Ten patients died of their disease, with an average survival of 14.4 months (range, 4-31 months) from the time of PTCD insertion. Three patients are still alive at 16, 21, and 8 months. Biliary tract patency was maintained until death. No serious treatment-related complications occurred, and no endoprothesis or intraluminal brachytherapy was needed in this study. CONCLUSIONS Satisfactory palliation can be achieved by concomitant chemoradiation for patients with obstructive jaundice resulting from extrahepatic biliary metastases from gastric carcinoma, providing an alternative treatment choice for these patients.
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Affiliation(s)
- S S Lo
- Division of General Surgery, Department of Surgery, Veterans General Hospital-Taipei and National Yang Ming University, Taipei, Taiwan
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Abstract
Alterations of protein tyrosine kinase are often associated with uncontrolled cell growth and tumor progression. Knowledge of the overall expression pattern of tyrosine kinases should prove beneficial in understanding the signaling pathways involved in gastric cancer oncogenesis and in providing possible biomarkers for gastric cancer progression. To establish a general tyrosine-kinase expression profile, degenerated polymerase chain reaction primers designed from the consensus catalytic kinase motifs were used to amplify protein tyrosine kinase molecules from gastric cancer tissues. We observed more than 50 tyrosine and serine/threonine kinases from matching pairs of gastric cancer tissue and normal mucosa. Based on this new kinase profile information, we selected the MKK4 gene for further immunohistochemical studies. Statistical analysis of MKK4 protein expression and clinicopathological features indicated that MKK4 kinase expression could serve as a significant prognostic factor for relapse-free survival and for overall survival. We demonstrated a simple and sensitive method for establishing protein tyrosine-kinase expression profiles of human gastric cancer tissues as well as for discovering novel and useful clinical biomarkers from such kinase expression profiles.
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Affiliation(s)
- C W Wu
- Department of Surgery, Veterans General Hospital-Taipei and School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Wu CW, Lo SS, Shen KH, Hsieh MC, Lui WY, P'eng FK. Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg 2000; 24:465-72. [PMID: 10706921 DOI: 10.1007/s002689910074] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although there were some studies on clinicopathologic characteristics, operative morbidity, and mortality in elderly patients with gastric cancer, no reports have specifically focused on survival and quality of life after resection. A total of 433 patients aged >/= 65 years (1987-1994) who underwent gastric resection for gastric adenocarcinoma were studied. Two groups were considered: patients aged 65 to 74 years and those > 74 years. Most of the patients (78.1%) had advanced diseases, and nearly half (41. 3%) had associated chronic disease(s). Resections with curative intention were performed in 362 patients (83.6%). The overall operative morbidity rate was 21.7% and mortality rate 5.1%. Although operative procedures were similar in both groups, patients aged >74 years had a higher mortality rate than those aged 65 to 74 years (10. 1% vs. 3.5%; p = 0.034). Age and extent of gastric resection were two independent factors negatively affecting mortality. The cumulative survival rates for patients who underwent curative resection were 86.2%, 72.4%, 67.2%, 62.9%, and 60.0% at 1, 2, 3, 4, and 5 years, respectively. Nearly all patients (96%) after surgery had normal work and daily activities. Some patients appeared to lack energy (16%) or experienced a period of anxiety or depression. There was no statistical difference in survival and quality of life assessed by the Spitzer index after curative resection between the two groups. Therefore resection with curative intention can be performed for the elderly with acceptable morbidity and mortality rates, possible long-term survival, and good quality of life, but a limited operation should be considered in the very elderly patients.
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Affiliation(s)
- C W Wu
- Department of Surgery, Veterans General Hospital-Taipei, Shih-Pai, Taipei, Taiwan 11217, Republic of China
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Shen KH, Chi CW, Lo SS, Kao HL, Lui WY, Wu CW. Serum matrix metalloproteinase-9 level associated with stromal reaction in patients with gastric cancer. Anticancer Res 2000; 20:1307-10. [PMID: 10810440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Matrix metalloproteinase 9 (MMP-9) plays an important role in cancer invasion and metastasis. The relationship between serum MMP-9 levels and clinicopathological factors in gastric cancer patients is not clear. MATERIALS AND METHODS Preoperative serum was obtained from 170 patients who had undergone gastrectomy for gastric cancer at the Veterans General Hospital-Taipei. The serum MMP-9 level was measured using a sandwich enzyme-linked immunoassay by monoclonal antibodies. RESULTS The median serum MMP-9 level was 368.6 ng/mL (range: 43.9-1871.3 ng/mL). Univariate analysis showed that stromal reaction and Lauren's histological classification were two factors related to serum MMP-9 levels (p = 0.014 and p = 0.030 respectively). Multivariate analysis revealed that stromal reaction was the only factor independently (odds ratio: 1.695) associated with MMP-9 levels. Patients with a serum MMP-9 level < 368.5 ng/mL had a tendency towards better survival rate (5-year survival rate: 64.4%) than those with > 368.5 ng/mL (58.5%), but this tendency did not reach statistical significance (p = 0.512). CONCLUSION These data suggests that serum MMP-9 levels are associated with stromal reaction in gastric cancer.
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Affiliation(s)
- K H Shen
- Department of Surgery, Veterans General Hospital-Taipei, Republic of China
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Shen KH, Shiao AS. Acute necrotizing otitis media in an infant: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1999; 62:175-8. [PMID: 10222606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Acute necrotizing otitis media (ANOM), an uncommon but severe form of bacterial otitis media, frequently causes distressing sequelae if not properly diagnosed and treated. A four-month-old female infant initially became ill with intermittent fever, followed by left facial nerve paralysis and left otorrhea four days later. Microscopic examination of the left ear revealed congestion and swelling of the external ear canal, perforation of the eardrum and erosions on the malleus. Culture of pus from the otic lesion grew Pseudomonas aeruginosa. The patient's condition did not improve despite systemic administration of antibiotics; thus, surgical intervention was arranged. During the operation, near-total perforation of the eardrum, a dislodged incus, cholesteatoma-like matrix around the stapes, and granulation tissue occupying the middle ear and mastoid cavities were noted. Radical mastoidectomy was conducted and pathologic examination of the surgical specimen disclosed necrotic changes in both soft and bony tissues. The patient recovered soon after surgery. Her fever subsided one day after surgery and the patient was discharged in a stable condition 12 days later. However, she still had left facial nerve paralysis six months later.
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Affiliation(s)
- K H Shen
- Department of Otolaryngology, Veterans General Hospital-Taipei, Taiwan, ROC
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Abstract
OBJECTIVE We had previously reported a reasonable categorization of the number of positive lymph nodes (LN: 0, 1-4, 5-8, and > 8) as a prognostic indicator. This study was an extension, to see which factors correlated with number of positive lymph nodes. METHODS A total of 533 patients with gastric adenocarcinoma, who underwent curative surgery between January 1988 and December 1995, were entered into this study. Patients were divided into four groups according to metastatic LN number (0, 1-4, 5-8, and > 8). Their survival and clinicopathological factors were analyzed. RESULTS A total of 16,457 LNs, with an average of 30.9 per specimen, were removed, of which 1686 (10.2%) showed metastases. The 5-yr cumulative survival rate decreased as the number of metastatic LNs increased, ie., 91.3% for LN 0; 67.4% for LN 1-4; 37.2 for LN 5-8, and 14.1% for LN > 8. Multivariate analyses showed that depth of cancer invasion (odds ratio: 2.4), gross appearance (odds ratio: 1.9), size (odds ratio: 1.9), and location (odds ratio: 1.4) of tumor were four independent factors correlated with the number of metastatic LNs. Number of metastatic LNs increased with advanced Japanese nodal stage and UICC-TNM stage. CONCLUSIONS Depth of tumor invasion, and gross appearance, size, and location of tumor were four pathological factors independently correlated with number of metastatic LNs in gastric cancer.
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Affiliation(s)
- K H Shen
- Department of Surgery and Biostatistic Information Service Center, Veterans General Hospital-Taipei and National Yang Ming University, Taiwan, R.O.C
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Wu CW, Chi CW, Hsieh MC, Lo SS, Shen KH, Lui WY, P'eng FK. Serum progesterone levels in patients with gastric adenocarcinoma before and after gastrectomy. Cancer 1998; 83:445-8. [PMID: 9690536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Having observed that progesterone receptors exist in all gastric carcinoma tissues, the authors determined that serum progesterone levels in gastric carcinoma patients were worthy of evaluation. METHODS Serum progesterone levels were determined in patients with gastric adenocarcinoma and in patients with benign disease who served as controls. All female patients were older than 55 years. The clinicopathologic significance of their serum progesterone levels was determined. RESULTS In male patients (n = 122), the serum progesterone level (mean +/- standard deviation) was significantly higher than in the male control group (n = 163) (0.264+/-0.261 vs. 0.142+/-0.113 ng/mL; P < 0.001) and showed a tendency to be stage-related (P = 0.029). Serum progesterone levels significantly decreased after gastrectomy in patients with disease at Stage I (n = 27), II (n = 20), and III (n = 32), but not IV (n = 7). In 11 patients who died of recurrence, the serum progesterone levels were decreased when they were disease free but raised when recurrence was clinically evident. Patients with serum progesterone levels > 0.264 ng/mL survived for significantly shorter periods than those with levels < or = 0.264 ng/mL (P = 0.039). However, serum progesterone level was not an independent predictor of survival. Among the female patients (n = 12), the serum progesterone level (mean +/- standard deviation) of patients with gastric carcinoma was 0.427+/-0.428 ng/mL, whereas that of the control group (n = 17) was 0.217+/-0.451 ng/mL; the difference was statistically significant (P = 0.02). In female disease free patients studied postoperatively, the progesterone after gastrectomy showed a tendency to decrease, but this difference was not statistically significant (0.444+/-0.368 vs. 0.175+/-0.150 ng/mL; P = 0.091; n = 7). CONCLUSIONS These data suggest that serum progesterone level reflects the presence or absence of gastric carcinoma by some unknown mechanism.
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Affiliation(s)
- C W Wu
- Department of Surgery, Veterans General Hospital-Taipei and School of Medicine, National Yang-Ming University, Taiwan, Republic of China
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Wung SC, Wu HP, Kou YH, Shen KH, Koh FK, Wan WC. Effect of thyrotropin-releasing hormone on serum thyroxine of lactating sows and the growth of their suckling young. J Anim Sci 1977; 45:299-304. [PMID: 409704 DOI: 10.2527/jas1977.452299x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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