Round block technique is a useful oncoplastic procedure for multicentric fibroadenomas

PURPOSE

Multicentric fibroadenomas, defined as multiple fibroadenomas located at different quadrants of the breast, occur in 10-20% of women with fibroadenoma. The surgical management of multicentric fibroadenomas may be troublesome for surgeons and patients. In this study, we report our preliminary experience using the "round block technique" in the management of women with multicentric fibroadenomas of the breast.

MATERIALS AND METHODS

Records of patients with breast diseases managed with the round block technique were searched for in the Changhua Christian Hospital oncoplastic breast surgery database. The patients' clinicopathologic characteristics, type of surgery, operation time, blood loss, and complications were recorded. The cosmetic outcome was evaluated by the patient and operating surgeon two months after the surgery.

RESULTS

Twenty patients with multicentric fibroadenomas managed by the round block technique comprised the current study cohort. The mean age of the subjects was 36.5 ± 10.4 years. Twelve (60%) patients had tumors on one side of the breast, and eight (40%) had bilateral breast lesions. The average number of tumors removed was 3.3 ± 1.2 (range 2-6) per breast, and mean tumor size was 2.2 ± 0.5 cm. Three (15%) patients developed mild ecchymosis of the breast undergoing operation, which resolved spontaneously. One (5%) patient had partial nipple ischemia/necrosis due to 2 tumors excised near the nipple-areolar complex. The aesthetic results were evaluated as good in 19 (95%) patients and fair in 1 (5%).

CONCLUSIONS

The round block technique is a useful oncoplastic procedure for the management of multicentric fibroadenomas excised at the same time.

Capsaicin may induce breast cancer cell death through apoptosis-inducing factor involving mitochondrial dysfunction

The majority of breast cancer patients are resistant to chemotherapy or radiotherapy due to the down-regulation or lack of caspase-3 expression. Capsaicin was found to inhibit cancer cell growth in caspase-3-deficient human breast cancer cells. This study aimed to investigate the growth-inhibitive effect of capsaicin and its mechanisms in human breast cancer cell lines, MCF-7 and BT-20. The results showed that cell viability decreased in a dose-dependent manner in both the caspase-3-deficient and non-deficient cells through inducing cell apoptosis and arresting the cell cycle in the S phase. Capsaicin significantly decreased mitochondria membrane potential, induced the cleavage of PARP-1, and decreased procaspase-7 expression in both cells. Apoptosis-inducing factor (AIF) was distinctly released from mitochondria and translocated into the cytoplasm and nucleus in MCF-7 cells (52.9%), but not in BT-20 cells (2%) after treatment with 200 μM of capsaicin for 24 hours. Capsaicin inhibited breast cancer cell growth through inducing cell apoptosis and cell cycle arrest in the S phase. This apoptotic effect could be induced through the mitochondrial pathway, and PARP-1 subsequently cleaved by activation of caspase-7. The application of capsaicin in clinical therapy could be useful for breast cancer patients.

Prognostic significance of triple negative breast cancer at tumor size 1 cm and smaller

AIMS

The purpose of this study was to clarify the prognostic significance of triple-negative breast cancer (TNBC) with a tumor size ≤ 1 cm.

MATERIALS AND METHODS

Patients with primary operable breast cancer with a tumor size ≤ 1 cm were enrolled at Changhua Christian Hospital and National Cheng-Kung University Hospital. Tumors negative for ER, PR, and HER-2 were classified as TNBCs and compared with tumors with any receptor positivity (non-TNBC) for disease-free survival (DFS) and cancer-specific survival (CSS).

RESULTS

From 1995 to 2006, a total of 377 patients with tumor size ≤ 1 cm were enrolled. Compared with non-TNBC patients, TNBC patients with a tumor size ≤ 1 cm as a whole or in a lymph node-positive subgroup were not associated with a poorer 5-year DFS and CSS. In lymph node-negative patients (pT1a-bN0M0), TNBC was associated with a poorer 5-year CSS but not DFS. Compared with the hormone receptor-positive, HER-2-negative subgroup, TNBC was associated with poorer DFS and CSS. In the multivariate Cox regression hazard analysis, lymph node invasion was the most important cause of disease recurrence and cancer-specific death.

CONCLUSION

TNBC is very likely an independent risk factor in small (≤1 cm) node-negative invasive breast cancer. With tumors 1 cm and smaller, lymph node invasion was the single most important prognostic factor.

Genetic evaluation and management of fetal chylothorax: review and insights from a case of Noonan syndrome

Fetal chylothorax is one of a very few syndromes that can be treated in utero with thoracoamniotic shunting or pleurodesis by OK-432 as two major therapeutic modalities. We report on a fetus with Noonan syndrome and a missense mutation c.182A > C (p.Asp61Ala) of PTPN11 who responded poorly to antenatal pleurodesis by OK-432. Based on our previous publication and this case study, we propose that fetal chylothorax of a distinct genetic origin may respond poorly to OK-432 pleurodesis.

Hand-assisted laparoscopic colon mobilization for esophageal reconstruction

BACKGROUND

New techniques for hand-assisted laparoscopic colon surgery have been adopted quickly for the treatment of numerous colorectal diseases. However, reports of laparoscopic colonic mobilization for esophageal reconstruction are rare. In this report we describe an improved procedure for esophageal reconstruction with transverse colon.

METHODS

From January 1999 to April 2001, we recruited seven patients (5 women and 2 men) who acquired esophageal stricture after swallowing hydrogen chloride or lye. The mean age of the patients was 42.7 years. For surgery, the patients were placed in lithotomy position under single-lumen intubated anesthesia. First, hand-assisted laparoscopic colon mobilization was performed with the assistance of the Harmonic Scalpel (AutoSuture Company, Norwalk, CT, USA) through a 7-cm upper abdominal incision. Then using cervical esophagocolostomy through the retrosternal route, coloenterostomy and colocolostomy were achieved.

RESULTS

The mean operative time was 3.9 h (range, 3.2-5 h). The mean hospital stay was 9.1 days (range, 8-13 days). Mean blood loss was 100 ml (range, 50-350 ml). All the patients obtained successful outcomes. There was one mild abdominal wound infection, and no surgical mortality. At this writing, the seven patients can eat solid food very well after a mean follow-up period of 18.2 months.

CONCLUSIONS

Hand-assisted laparoscopic colonic mobilization for esophageal reconstruction is a safe and feasible operation for treating patients with esophageal stricture.

Optical detection and charge-state analysis of MALDI-generated particles with molecular masses larger than 5 MDa

Charged polystyrene nanoparticles are generated by matrix-assisted laser desorption/ionization (MALDI) and detected by laser-induced fluorescence (LIF) in a quadrupole ion trap. Employing the LIF technique, observations of individual fluorescent nanospheres (27 nm in diameter and containing 180 fluorescein dye equivalents) have been achieved with an average signal-to-noise ratio of approximately 10. With the trap operating at a frequency around 5 kHz, charge state analysis of the particles reveals that the number of charges carried by the spheres is between 1 and 10. It suggests a mass-to-charge ratio (m/z) in the range of 10(5)-10(6) for the MALDI-generated particles. To effectively trap such large particles (m > 5 MDa), damping of the particles' motions by using approximately 50 mTorr He buffer gas is absolutely required. Similar findings are obtained for particles with a nominal size of 1 microm in diameter, demonstrating that production of charged particles with a molecular mass as high as 10(12) Da is possible using the MALDI technique.

Single-particle mass spectrometry of polystyrene microspheres and diamond nanocrystals

High-resolution mass spectra of single submicrometer-sized particles are obtained using an electrospray ionization source in combination with an audio frequency quadrupole ion-trap mass spectrometer. Distinct from conventional methods, light scattering from a continuous Ar-ion laser is detected for particles ejected out of the ion trap. Typically, 10 particles are being trapped and interrogated in each measurement. With the audio frequency ion trap operated in a mass-selective instability mode, analysis of the particles reveals that they all differ in mass-to-charge ratio (m/z), and the individual peak in the observed mass spectrum is essentially derived from one single particle. A histogram of the spectra acquired in 10(2) repetitions of the experiment is equivalent to the single spectrum that would be observed when an ion ensemble of 10(3) particles is analyzed simultaneously using the single-particle mass spectrometer (SPMS). To calibrate such single-particle mass spectra, secular frequencies of the oscillatory motions of the individual particle within the trap are measured, and the trap parameter qz at the point of ejection is determined. A mass resolution exceeding 10(4) can readily be achieved in the absence of ion ensemble effect. We demonstrate in this work that the SPMS not only allows investigations of monodisperse polystyrene microspheres, but also is capable of detecting diamond nanoparticles with a nominal diameter of 100 nm, as well.

Alteration in the expression of protein kinase C isoforms in human hepatocellular carcinoma

This study was designed to investigate the alterations of individual protein kinase C (PKC) isoforms in human liver cancer. Surgical specimens of hepatocellular carcinoma and adjacent normal tissues were extracted into cytosolic and membranous fractions. The level of membrane-bound PKCalpha in the cancer tissue was significantly lower than that in the adjacent normal tissue and consistent with the change in PKC activity. In addition, there was a significant negative correlation between PKCalpha and tumor size. In both cytosolic and membrane fractions, levels of PKCdelta and PKCzeta was significantly higher in the cancer tissue than those in the adjacent normal liver tissue. The alterations in the PKC isoforms signify their roles in the hyperproliferation in liver cancer.

Large-scale preparation of a ribonuclease from Rana catesbeiana (bullfrog) oocytes and characterization of its specific cytotoxic activity against tumor cells

Rana catesbeiana ribonuclease (RC-RNase) is a pyrimidine-guanine sequence-specific ribonuclease found only in R. catesbeiana (bullfrog) oocytes, but not in other organs. The protein is localized in the yolk granules of oocytes but not in other organelles, as detected by immunohistochemistry. More than 99% of RC-RNase was found in the yolk granule pellet when a mild separation method was employed under physiological conditions. The ribonuclease was purified by precipitation of yolk granules, extraction of RC-RNase with 0.09 M NaCl, selective removal of impurities by Hepes buffer, and chromatographies on phosphocellulose and carboxymethyl cellulose columns. Three milligrams of RC-RNase was purified from a 1-g pellet of yolk granules prepared from 2 g of ovary tissue. Therefore, 150 milligrams of RC-RNase could be obtained from a mature female bullfrog (600 g in weight) which had 100 g of ovary tissue. The properties of RC-RNase isolated from yolk granules tested so far are identical to those of RC-RNase isolated from the cytosolic fraction and similar to those of a sialic acid-binding lectin from bullfrog oocytes. To investigate the possible role of RC-RNase in the regulation of cell growth and differentiation during embryogenesis, its cytotoxic activity against various cell lines was examined. The degradation of ribosomal RNA was found in RC-RNase-treated HeLa cells. However, both events were not found in RNase A-treated HeLa cells. Therefore, RC-RNase is proposed to have both ribonucleolytic and cytotoxic activity and a specific receptor on the tumor cell surface is suspected to be involved in the recognition and binding, and possibly entry of RC-RNase.

Evaluation of the CO2 laser in performance of breast surgery

BACKGROUND

In several studies the CO2 laser has proved to have properties which make it particularly useful to the general surgeon in management of breast tumor.

METHODS

Four hundred and seventy-two patients, including 2 males, which age range from 15 to 84 years. The operative procedures included excisional biopsy, segmentectomy and modified radical mastectomy. In this study, one group was operated on by the scalpel; for the other group CO2 Laser (Sharplan Model 733) was used. This is a comparison of the healing process, the operative course and follow-up of patients who underwent breast surgery. Eighteen of this series were fresh, locally advanced mammary carcinoma cases and were managed with induction chemotherapy using cyclophosphamide, adriamycin, 5-fluorouracil, followed by definitive extirpative laser surgery.

RESULTS

The patient have been followed up from 12 to 60 months. Good cosmetic results without local recurrence of tumor were observed following the laser treatment. An effective massive tumor necrosis of 80% occurred after induction chemotherapy. Swelling and distortion of cancer cells with vesicles filling in the cytoplasm and nucleus were demonstrated.

CONCLUSIONS

Laser technology for breast surgery was concluded to assist the operating surgeon with more precision, smaller wounds, more hemostasis, less tissue damage, and reduced morbidity except prolonged wound healing.

Chilling-Induced Lipid Degradation in Cucumber (Cucumis sativa L. cv Hybrid C) Fruit

Chilling at 4 degrees C in the dark induced lipid degradation in cucumber (Cucumis sativa L.) fruit upon rewarming at 14 degrees C. Rates of ethane evolution by fruits rewarmed after 3 days of chilling were up to four-fold higher than those evolved by unchilled (14 degrees C) fruits (0.02-0.05 picomoles gram fresh weight(-1) hour(-1)). This potentiation of lipid peroxidation occurred prior to irreversible injury (requiring 3 to 7 days of chilling) as indicated by increases in ethylene evolution and visual observations. Decreases in unsaturation of peel tissue glycolipids were observed in fruits rewarmed after 3 days of chilling, indicating the plastids to be the site of the early phases of chilling-induced peroxidation. Losses in unsaturation of tissue phospholipids were first observed only after chilling for 7 days. Phospholipase D activity appeared to be potentiated in fruits rewarmed after 7 days of chilling as indicated by a decrease in phosphatidylcholine (and secondarily phosphatidylethanolamine) with a corresponding increase in phosphatidic acid. These results indicate that lipid peroxidation may have a role in conferring chilling injury.