Comparative outcomes of phacoemulsification combined with micro-invasive glaucoma surgery plus: Schlemm canal microstent versus Ab interno trabecular excision

PURPOSE

To report the relative efficacy of combining phacoemulsification with a Schlemm's canal microstent (Phaco/Hydrus) or dual blade trabecular excision (Phaco/KDB).

DESIGN

Retrospective study.

METHODS

One hundred and thirty-one eyes of 131 patients who underwent Phaco/Hydrus or Phaco/KDB procedures from January 2016 to July 2021 at a tertiary care center were included and assessed for up to 36months postoperatively. Primary outcomes were intraocular pressure (IOP) and number of glaucoma medications, evaluated by generalized estimating equations (GEE). Two Kaplan-Meier estimates (KM) assessed survival without additional intervention or pressure lowering medication while maintaining: (1) IOP≤21mmHg and≥20% IOP reduction or (2) IOP≤preoperatively designated goal.

RESULTS

Mean preoperative IOP was 17.70±4.91 (SD) mmHg on 0.28±0.86 medications in the Phaco/Hydrus cohort (n=69) and 15.92±4.34mmHg on 0.19±0.70 medications in the Phaco/KDB cohort (n=62). At 12months, mean IOP was reduced to 14.98±2.77mmHg on 0.12±0.60 medications after Phaco/Hydrus and 13.52±4.13mmHg on 0.04±0.19 medications after Phaco/KDB. GEE models of IOP (P<0.001) and medication burden (P<0.05) showed significant patterns of reduction across all timepoints in both cohorts. There were no differences in IOP reduction (P=0.94), number of medications (P=0.95) or survival (P=0.72 by KM1, P=0.11 by KM2) between procedures.

CONCLUSIONS

Both Phaco/Hydrus and Phaco/KDB resulted in significantly reduced IOP and medication burden for over 12months. Phaco/Hydrus and Phaco/KDB confer similar outcomes in terms of IOP, medication burden, survival, and procedural time in a population with predominantly mild and moderate open-angle glaucoma.

How Does Robotic-Arm Assisted Technology Influence Total Knee Arthroplasty Implant Placement for Surgeons in Fellowship Training?

Implant malalignment during total knee arthroplasty (TKA) may lead to suboptimal postoperative outcomes. Accuracy studies are typically performed with experienced surgeons; however, it is important to study less experienced surgeons when considering teaching hospitals where younger surgeons operate. Therefore, this study assessed whether robotic-arm assisted TKA (RATKA) allowed for more accurate and precise implant position to plan when compared with manual techniques when the surgery is performed by in-training orthopaedic surgical fellows. Two surgeons, currently in their fellowship training and having minimal RATKA experience, performed a total of six manual TKA (MTKA) and six RATKAs on paired cadaver knees. Computed tomography scans were obtained for each knee pre- and postoperatively. These scans were analyzed using a custom autosegmentation and autoregistration process to compare postoperative implant position with the preoperative planned position. Mean system errors and standard deviations were compared between RATKA and MTKA for the femoral component for sagittal, coronal, and axial planes and for the tibial component in the sagittal and coronal planes. A 2-Variance testing was performed using an α = 0.05. Although not statistically significant, RATKA was found to have greater accuracy and precision to plan than MTKA for: femoral axial plane (1.1° ± 1.1° vs. 1.6° ± 1.3°), coronal plane (0.9° ± 0.7° vs. 2.2° ± 1.0°), femoral sagittal plane (1.5° ± 1.3° vs. 3.1° ± 2.1°), tibial coronal plane (0.9° ± 0.5° vs. 1.9° ± 1.3°), and tibial sagittal plane (1.7° ± 2.6° vs. 4.7° ± 4.1°). There were no statistical differences between surgical groups or between the two surgeons performing the cases. With limited RATKA experience, fellows showed increased accuracy and precision to plan for femoral and tibial implant positions. Furthermore, these results were comparable to what has been reported for an experienced surgeon performing RATKA.

Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Soft Tissue Protection

INTRODUCTION

While total knee arthroplasty (TKA) procedures have demonstrated clinical success, occasionally intraoperative complications can occur. Collateral or posterior cruciate ligament injury, instability, extensor mechanism disruption, and tibiofemoral or patellofemoral dislocation are among a few of the intraoperatively driven adverse events prevalently ranked by The Knee Society. Robotic-arm assisted TKA (RATKA) provides a surgeon the ability to three-dimensionally plan a TKA and use intraoperative visual, auditory, and tactile feedback to ensure that only the desired bone cuts are made. The potential benefits of soft tissue protection in these surgeries need to be further evaluated. The purpose of this cadaver study was to assess the a) integrity of various knee soft tissue structures (medial collateral ligament [MCL], lateral collateral ligament [LCL], posterior cruciate ligament [PCL], and the patellar ligament), as well as b) the need for tibial subluxation and patellar eversion during RATKA procedures.

MATERIALS AND METHODS

Six cadaver knees were prepared using RATKA by a surgeon with no prior clinical robotic experience. These were compared to seven manually performed cases as a control. The mean Kellgren-Lawrence score was 2.8 (range, 0 to 4) in RATKA and 2.6 (range, 1 to 4) in the manual cohort. The presence of soft tissue damage was assessed by having an experienced surgeon perform a visual evaluation and palpation of the PCL, MCL, LCL, and the patellar ligament after the procedures. In addition, leg pose and retraction were documented during all bone resections. The amount of tibial subluxation and patellar eversion was recorded for each case.

RESULTS

For all RATKA-assisted cases, there was no visible evidence of disruption of any of the ligaments. All RATKA cases were left with a bone island on the tibial plateau, which protected the PCL. Tibial subluxation and patella eversion were not required for visualization in any RATKA cases. In two of the seven MTKA cases, there was slight disruption noted of the PCL, although this did not lead to any apparent change in the functional integrity of the ligament. All MTKA cases required tibial subluxation and patellar revision to achieve optimal visualization.

DISCUSSION

Several aspects of soft tissue protection were noted during the study. During bone resections, the tibia in RATKA procedures did not require subluxation, which may reduce ligament stretching or decrease complication rates. Potential patient benefits for short-term recovery and decreased morbidity to reduce operative complications should be studied in a clinical setting. Since RATKA uses a stereotactic boundary to constrain the sawblade, which is generated based on the implant size, shape, and plan, and does not have the ability to track the patient's soft tissue structures, standard retraction techniques during cutting are recommended. Therefore, the retractor placement and potential for soft tissue protection needs to be further investigated. RATKA has the potential to increase soft tissue protection when compared to manual TKA.

Electricity production from municipal solid waste using microbial fuel cells

The organic content of municipal solid waste has long been an attractive source of renewable energy, mainly as a solid fuel in waste-to-energy plants. This study focuses on the potential to use microbial fuel cells to convert municipal solid waste organics into energy using various operational conditions. The results showed that two-chamber microbial fuel cells with carbon felt and carbon felt allocation had a higher maximal power density (20.12 and 30.47 mW m(-2) for 1.5 and 4 L, respectively) than those of other electrode plate allocations. Most two-chamber microbial fuel cells (1.5 and 4 L) had a higher maximal power density than single-chamber ones with corresponding electrode plate allocations. Municipal solid waste with alkali hydrolysis pre-treatment and K3Fe(CN)6 as an electron acceptor improved the maximal power density to 1817.88 mW m(-2) (~0.49% coulomb efficiency, from 0.05-0.49%). The maximal power density from experiments using individual 1.5 and 4 L two-chamber microbial fuel cells, and serial and parallel connections of 1.5 and 4 L two-chamber microbial fuel cells, was found to be in the order of individual 4 L (30.47 mW m(-2)) > serial connection of 1.5 and 4 L (27.75) > individual 1.5 L (20.12) > parallel connection of 1.5 and 4 L (17.04) two-chamber microbial fuel cells . The power density using municipal solid waste microbial fuel cells was compared with information in the literature and discussed.

A cluster of Mycobacterium massiliense keratitis in foundry workers

Three consecutive workers from the same foundry had Mycobacterium massiliense keratitis. The strains isolated from each patient were identical. This is the first report of a non-surgery-related outbreak of non-tuberculous mycobacterial ocular infection. An investigation revealed that injured cornea with exposure to aerosolized non-tuberculous mycobacteria might account for this outbreak.

Phase I study of nanoliposomal irinotecan (PEP02) in advanced solid tumor patients

Purpose

To define the dose-limiting toxicity (DLT), maximum tolerated dose (MTD) and pharmacokinetics (PK) of PEP02, a novel liposome-encapsulated irinotecan, in patients with advanced refractory solid tumors.

Methods

Patients were enrolled in cohorts of one to three to receive escalating dose of PEP02 in a phase I trial. PEP02, from 60 to 180 mg/m², was given as a 90-min intravenous infusion, every 3 weeks.

Results

A total of 11 patients were enrolled into three dose levels: 60 (one patient), 120 (six patients) and 180 mg/m² (four patients). DLT was observed in three patients, one at 120 mg/m² (grade 3 catheter-related infection) and two at 180 mg/m² (grade 4 neutropenia lasting for >3 days in one, grade 4 hematological toxicities and grade 4 diarrhea in the other). MTD was determined as 120 mg/m². Comparing with those after free-form irinotecan in the literature, the dose-normalized PK of SN-38 (the active metabolite) after PEP02 was characterized by lower C_max, prolonged terminal half-life and higher AUC but with significant inter-individual variation. One patient who died of treatment-related toxicity had significantly higher C_max and AUC levels of SN-38 than those of the other three patients at 180 mg/m². Post hoc pharmacogenetic study showed that the patient had a combined heterozygosity genotype of UGT1A1*6/*28. Two patients had objective tumor response.

Conclusions

PEP02 apparently modified the PK parameters of irinotecan and SN-38 by liposome encapsulation. The MTD of PEP02 monotherapy at 3-week interval is 120 mg/m², which will be the recommended dose for future studies.

Copy number variation of PRAMEY across breeds and its association with male fertility in Holstein sires

Multi-copy gene families are especially prevalent in the male-specific region (MSY) of the mammalian Y chromosome. Copy number variations (CNV) of these Y-linked gene families have been shown to affect human and animal fertility. The PRAMEY (Preferentially expressed antigen in melanoma, Y-linked) gene family is a newly identified, bovid-specific Y-linked gene family, which codes for a cancer/testis antigen that is expressed predominantly in testis and various tumors. The PRAMEY gene family is believed to play an important role in spermatogenesis and male fertility in cattle. The objective of this study was to investigate the CNV of PRAMEY within and across breeds and to determine whether CNV was associated with reproductive traits in Holstein bulls. A quantitative real-time PCR method was applied to measure the copy number of PRAMEY among 460 bulls using a Y-linked single copy gene, DDX3Y (DEAD box polypeptide 3, Y-linked), as a reference. The median copy number of PRAMEY was 13, ranging from 2 to 31. Significant variations in PRAMEY copy number were observed among 15 breeds investigated. Holstein bulls had the lowest median copy number (12), whereas Limousin bulls possessed the highest median copy number (26). Furthermore, bulls in the taurine lineage (13) had a significantly lower median copy number than those bulls in the indicine lineage (20). Association analysis revealed that PRAMEY copy number was correlated negatively with scrotal circumference (SC), relative scrotal circumference (RLSC), percentage of normal sperm (PNS), and nonreturn rate (NRR), but had no significant association with postthaw motility (PTM), incubated motility (IM), percentage of intact acrosome (PIA), sire conception rate (SCR), or relative breeding efficiency (RBE). The data from this study indicate that CNV of the PRAMEY gene family is associated with male reproductive traits and may serve as a valuable marker for sire fertility selection at an early age in cattle.

Respiratory and intestinal trichomoniasis in mule ducks

Two types of trichomoniasis, respiratory and intestinal, were found in two duck farms. Based on the morphological features, the organism was identified as Tetra-trichomonas anatis. In the first outbreak, main clinical signs were bilateral swelling of infraorbital sinuses, sneezing and profuse diarrhoea with high fatality (300/400) in young ducks. Histological lesions were confined to the upper respiratory tract and lower small intestine and consisted of mucofibrino-purulent sinusitis and catarrhal rhinitis, tracheitis and enteritis. The protozoa appeared frequently in the infraorbital sinuses, the respiratory region of the nose, and the lower small intestine, but rarely in the trachea. In the second outbreak, the lesions were limited to the lower small intestine with catarrhal enteritis in adult ducks clinically showing profuse diarrhoea and low mortality.

Inserting the tunneller during an outside-in transobturator tape procedure by syringe-needle guidance

The objective of this study was to determine the feasibility of a novel syringe-needle guidance technique (SNG), and its impact on the perioperative variables and outcomes of patients undergoing an outside-in transobturator tape procedure (TOT). Between November 2006 and May 2008, 48 consecutive women who underwent TOT with SNG were included. Another 25 women without SNG between March 2004 and October 2006 were included as a historical control. There were no significant differences in hospital stays and complication rates between the two groups. However, the operating time was shorter (mean 23.0 vs 28.3 min, p=0.008) in the SNG group than in the control group. The presence of the SNG technique was the sole predictor of the operating time (p=0.003). In conclusion, the SNG technique is a feasible method to provide help in inserting the tunneller of TOT through the transobturator foramen, and did not compromise the outcome.

A pre-operative approach of range of motion simulation and verification for femoroacetabular impingement

BACKGROUND

Femoroacetabular impingement (FAI) is increasingly recognized as a potential cause of hip osteoarthritis. A system capable of pre-operatively simulating hip range of motion (ROM) by given surface models from either healthy or FAI diseased bone is desirable.

METHODS

An impingement detection system using bounding sphere hierarchies was first developed. Both precision and accuracy of the impingement detection system were verified by a custom-designed phantom to imitate ball-and-socket hip movement. The impingement detection system was then implemented into the hip ROM simulation system to simulate the ROM of (1) healthy pelvis and femur, and (2) healthy pelvis and pathologic femur. The ROM simulation system was also verified by manipulating sawbones under the navigation of an optical tracking system.

RESULTS

The impingement detection system achieved a distance error of 0.53 ± 0.06 mm and an angular error of 0.28 ± 0.03°. The impingement detection accuracies were 100%, 100%, and 96% in three different phantom orientations, respectively. The mean errors between simulated and verified ROM were 0.10 ± 1.39° for the 'healthy pelvis and femur' group, and - 2.38 ± 3.49° for the 'healthy pelvis and pathologic femur' group.

CONCLUSION

The present study demonstrates a pre-operative approach to virtually simulate and predict the functional hip ROM based on the given bone models. The impingement detection and ROM simulation systems developed may also be used for other orthopedic applications.

Avian pox infection in a free-living crested serpent eagle (Spilornis cheela) in southern Taiwan

Avian pox viruses (APVs) have been reported to cause infection in diverse avian species worldwide. Herein we report the first case of APV infection in a free-living bird, a subadult crested serpent eagle (Spilornis cheela), in Taiwan. In addition to the typical wart-like lesions distributed on the cere, eyelid, and face, there were also yellowish nodules below the tongue and on the hard palate. Phylogenetic analysis of the 4b core protein gene showed that the APV is very close to that found in white-tailed sea eagle (Haliaeetus albicilla) in Japan recently. Because both cases are located on the same major flyway for migratory birds, the impact of this virus with regard to the wild and migratory raptor species along the East Asian-Australasian Flyway and West Pacific Flyway requires immediate investigation.

Mercury recovery from cold cathode fluorescent lamps using thermal desorption technology

Cold cathode fluorescent lamps (CCFLs) are globally used components of high technology products. A large amount of mercury in waste CCFLs is being recovered by thermal desorption technology in Taiwan. However, the complexity of the samples affects the thermal desorption efficiency and increases costs. This study identifies the mercury release behaviour of amalgam, phosphor and mercury-containing components as well as waste CCFLs by bench scale thermal desorption test. The results show that the mercury was released from amalgam and mercury/fluorescent powder from a real treatment plant at temperatures between 550 degrees C to 850 degrees C, which is much higher than from cinnabar at 300 degrees C to 380 degrees C and that of pure mercury, high pressure mercury lamps, and fluorescent tubes containing mercury/fluorescent-powder at 50 degrees C to 250 degrees C. In addition, the experiment also showed the mercury release peak of the mercury/fluorescent powders from a real treatment plant occurs at much higher temperatures than that of commercial phosphor at 50 degrees C to 200 degrees C. Thus, complete separation of the cracked CCFLs is necessary to effectively recover phosphor and mercury at low financial and energy cost.

Analysis of protein profiles in human epithelial ovarian cancer tissues by proteomic technology

BACKGROUND

Screening in ovarian cancer is progressively finding out candidate genes and proteins which may work as screening biomarkers and play a role in tumor progression. We examined the protein expression patterns of ovarian cancer tissues using two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization-time of fight mass spectrometry (MALDI-TOF MS).

METHODS

Tissues from 36 ovarian cancers and 20 normal ovaries were examined by 2-DE. The images of silver stained gels were analyzed by ImageMaster 2D Elite. The peptide mixtures, after in-gel digestion, were determined by MALDI-TOF MS for fingerprinting. The de-isotope tryptic peptide profiles were matched by using the Mascot search engine based on the entire NCBI and Swiss-Prot protein databases. Western/dot blots were then applied to verify the findings.

RESULTS

In ovarian cancer, 12 proteins that showed differential expressions were identified unequivocally. Among these proteins, five proteins (galectin-1, cathepsin B, ubiquitin carboxy-terminal hydrolase L1, HLA class II antigen DRB1-11 and heat shock protein 27) were up-regulated and seven proteins (cellular retinol-binding protein, transthyretin, SH3 binding glutamic-rich-like protein, tubulin-specific chaperone A, DJ-1, gamma-actin and tropomyosin 4) were down-regulated.

CONCLUSION

The present study is the first to report the up-regulation of ubiquitin carboxy-terminal hydrolase L1 and the down-regulation of SH3 binding glutamic-rich-like protein, tubulin-specific chaperone A, and tropomyosin 4 in human ovarian cancer tissues. Further cloning and functional analysis of these salient proteins will provide more information on their pathophysiologic roles in ovarian cancer.

A material flow of lithium batteries in Taiwan

Li batteries, including secondary and cylindrical/button primary Li batteries, are used worldwide in computers, communications and consumer electronics products. However, there are several dangerous issues that occur during the manufacture, shipping, and storage of Li batteries. This study analyzes the material flow of lithium batteries and their valuable heavy metals in Taiwan for the year 2006 by material flow analysis. According to data from the Taiwan Environmental Protection Administration, Taiwan External Trade Development Council, Bureau of Foreign Trade, Directorate General of Customs, and the Li batteries manufactures/importers/exporters. It was found that 2,952,696 kg of Li batteries was input into Taiwan for the year 2006, including 2,256,501 kg of imported Li batteries and 696,195 kg of stock Li batteries in 2005. In addition, 1,113,867 and 572,215 kg of Li batteries was domestically produced and sold abroad, revealing that 3,494,348 kg of different types of Li batteries was sold in Taiwan. Of these domestically sold batteries, 504,663 and 146,557 kg were treated domestically and abroad. Thus, a total of 2,843,128 kg of Li batteries was stored by individual/industry users or illegally disposed. In addition, it was also observed that 2,120,682 kg of heavy metals contained in Li batteries, including Ni, Co, Al, Cu and Ni, was accumulated in Taiwan, with a recycled value of 38.8 million USD. These results suggest that these heavy metals should be recovered by suitable collection, recycling and reuse procedures.

Treating high-mercury-containing lamps using full-scale thermal desorption technology

The mercury content in high-mercury-containing lamps are always between 400 mg/kg and 200,000 mg/kg. This concentration is much higher than the 260 mg/kg lower boundary recommended for the thermal desorption process suggested by the US Resource Conservation and Recovery Act. According to a Taiwan EPA survey, about 4,833,000 cold cathode fluorescent lamps (CCFLs), 486,000 ultraviolet lamps and 25,000 super high pressure mercury lamps (SHPs) have been disposed of in the industrial waste treatment system, producing 80, 92 and 9 kg-mercury/year through domestic treatment, offshore treatment and air emissions, respectively. To deal with this problem we set up a full-scale thermal desorption process to treat and recover the mercury from SHPs, fluorescent tube tailpipes, fluorescent tubes containing mercury-fluorescent powder, and CCFLs containing mercury-fluorescent powder and monitor the use of different pre-heating temperatures and desorption times. The experimental results reveal that the average thermal desorption efficiency of SHPs and fluorescent tube tailpipe were both 99.95%, while the average thermal desorption efficiencies of fluorescent tubes containing mercury-fluorescent powder were between 97% and 99%. In addition, a thermal desorption efficiency of only 69.37-93.39% was obtained after treating the CCFLs containing mercury-fluorescent powder. These differences in thermal desorption efficiency might be due to the complexity of the mercury compounds contained in the lamps. In general, the thermal desorption efficiency of lamps containing mercury-complex compounds increased with higher temperatures.

Antiproliferative effects of 2-methoxyestradiol alone and in combination with chemotherapeutic agents on human endometrial cancer cells

OBJECTIVE

2-methoxyestradiol (2-ME), an endogenous estradiol metabolite, has potent antiproliferative effects on cancer cells. However, its usefulness for treating endometrial cancer has not yet been fully explored. We investigated for the first time whether in vitro combinations of 2-ME with various chemotherapeutic agents might result in a synergistic inhibitory effect on the proliferation of human endometrial cancer cells.

METHODS

As a model, two different human endometrial cancer cell lines, HEC-1-A and RL95-2, were used. These cells were treated with 2-ME alone or in combination with paclitaxel, cisplatin, or doxorubicin. Measurements to detect an antiproliferative effect were performed after 24, 48, and 72 hours using the MTT assays.

RESULTS

In both endometrial cancer cell lines a significant synergistic effect of 2-ME with paclitaxel was observed. The combination of 2-ME and cisplatin was not synergistic and provided only additive effects. The antiproliferative effect of 2-ME was somewhat antagonized by doxorubicin.

CONCLUSIONS

Our study shows that 2-ME has a direct antiproliferative effect on endometrial cancer cells. Our results also show a potential anticancer synergy between 2-ME and paclitaxel in vitro. On the other hand, no remarkable synergistic actions were observed between 2-ME and doxorubicin, suggesting that 2-ME may selectively enhance the anticancer actions of certain chemotherapeutic agents in human endometrial cancer. Therefore, combination therapy should be investigated further as an additional therapeutic option for advanced or recurrent endometrial cancer.

Prognostic factors and adjuvant therapy in uterine carcinosarcoma

PURPOSE OF INVESTIGATION

The objective of this retrospective study was to investigate prognostic variables and impact of adjuvant therapy in uterine carcinosarcoma.

METHODS

The clinical information and pathological confirmation were reviewed for cases with uterine carcinosarcoma from 1984 to 2005. A total of 45 patients were eligible for analysis.

RESULTS

The median follow-up for survivors was 84 months. Five-year overall survival and progression-free survival (PFS) rates were 36.5% and 33.8%, respectively for Stage I-IV. Distant site metastasis with/without pelvic failure occurred in 83.3% of those with recurrence/progression. By multivariate analysis, older age (p = 0.001) and more than half of myometrial invasion (p = 0.002) were significant predictors of death, while only myometrial invasion (p = 0.022) was significantly associated with PFS. Stratified analyses demonstrated a monotonic trend of chemotherapy or chemoradiation to decrease death.

CONCLUSIONS

Our results suggested that age and depth of myometrial invasion were significant prognostic factors, and chemotherapy or chemoradiation seemed to be beneficial for uterine carcinosarcoma.

Computer-aided diagnosis system for acute stroke using diffusion weighted images with volume calculation

The diffusion weighted image (DWI) technique is routinely used for diagnosis and treatment of early stroke due to its superior performance, especially when it is compared with conventional magnetic resonance image (MRI) for detection of acute ischemic stroke. Using DWI examination, This work has proposed a computer-aided diagnosis system, which can effectively calculate the volume size of a lesion and provide clinical doctor the 3D reconstruction data of the lesion. The potential benefits of using our system include the higher accuracy of acute stroke lesion definition, the reduced time and procedure of calculating the volume of a lesion, and providing 3D reconstruction image of stroke patients, which can effectively assist doctors in making more accurate diagnoses and treating patients in a more convenient way. Compared with the traditional method, the experimental results have shown the superior performance of this proposed system.

The fate and management of high mercury-containing lamps from high technology industry

This study investigated the fate and management of high mercury-contained lamps, such as cold cathode fluorescent lamps (CCFLs), ultraviolet lamps (UV lamps), and super high pressure mercury lamps (SHPs), from high technology industries in Taiwan, using material flow analysis (MFA) method. Several organizations, such as Taiwan Environmental Protection Administration, Taiwan External Trade Development Council, the light sources manufactories, mercury-containing lamps importer, high technology industrial user, and waste mercury-containing lamps treatment facilities were interviewed in this study. According to this survey, the total mercury contained in CCFLs, UV lamps, and SHPs produced in Taiwan or imported from other countries was 886kg in year 2004. Among the various lamps containing mercury, 57kg mercury was exported as primary CCFLs, 7kg mercury was wasted as defective CCFLs, and 820kg mercury was used in the high technology industries, including 463kg mercury contained in exported industrial products using CCFLs as components. On the contrary, only 59kg of mercury was exported, including 57kg in CCFLs and 2kg in UV lamps. It reveals that 364kg mercury was consumed in Taiwan during year 2004. In addition, 140kg of the 364kg mercury contained in lamps used by high technology industry was well treated through industrial waste treatment system. Among the waste mercury from high technology industry, 80kg (57%), 53kg (38%), and 7kg (5%) of mercury were through domestic treatment, offshore treatment, and emission in air, respectively. Unfortunately, 224kg waste mercury was not suitable treated, including 199kg mercury contained in CCFL, which is a component of monitor for personal computer and liquid crystal display television, and 25kg non-treated mercury. Thus, how to recover the mercury from the waste monitors is an important challenge of zero wastage policy in Taiwan.

Unusual pox lesions found in Chinese jungle mynahs (Acridotheres cristatellus)

Pox lesions involving feathered and unfeathered skin, the oral cavity and the uropygial gland were found in Chinese jungle mynahs. Characteristic intracytoplasmic inclusions were detected in the proliferative cells of all lesions. Ultrastructurally, the virus particles consisted of a convoluted outer membrane enclosing lateral bodies and a biconcave central core, typical for poxvirus. The nucleotide sequences of the amplicon obtained with a set of primers for the 4b core protein of fowl poxvirus revealed that the mynah poxvirus was phylogenetically related to wood pigeon poxvirus. This is the first report of poxvirus infection affecting the uropygial gland.

Colloidal silica removal in coagulation processes for wastewater reuse in a high-tech industrial park

Four experiments of coagulation and flocculation were conducted to investigate the characteristics of colloidal silica removal in a high-tech industrial wastewater treatment plant for reclamation and reuse of the effluent. Experimental results illustrated that poly-aluminium chloride (PACl) showed higher performances on colloidal silica removal than alum. Interestingly, the two coagulants demonstrated the same capacity on silica removal. The specific silica removal capacity was approximately 0.135 mg SiO2/mg Al2O3 when the dosage of coagulants was in the range 30-150 mg/L Al2O3. In addition, the silica was reduced significantly at the condition of pH above 8. Experimental data implied that precipitation of aluminium flocs was the major mechanism for colloid silica removal in PACl and alum coagulation, besides, charge adsorption was also important for improving removal efficiency. Moreover, the addition of polyacrylic acid (PAA) as a flocculant could slightly advance silica removal in the PACl coagulation. The combined PACl/PAA/flocs coagulation was effective for the removal of colloidal silica, soluble COD, and turbidity and also suitable as a pretreatment unit in wastewater reclamation and reuse processes.

Supraclavicular lymph node metastases in cervical cancer

PURPOSE OF INVESTIGATION

To evaluate the outcome and prognostic factors of patients with supraclavicular lymph node (SCLN) involvement at primary diagnosis.

METHODS

We reviewed the medical records of cervical cancer patients primarily treated at Chang Gung Memorial Hospital between 1987 and 2005. Thirty-three patients with histologically confirmed SCLN metastasis at primary diagnosis were eligible for analysis. Clinical and pathological features were analyzed for association with outcome.

RESULTS

The 3- and 5-year survival rates of patients with SCLN metastasis were 16.5% and 16.5%, respectively. Multivariate analysis showed the serum level of squamous cell carcinoma antigen (SCC-Ag) < 15 ng/ml at initial diagnosis (p = 0.021) and staging/restaging including [18F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) (p = 0.006) to be associated with a better prognosis.

CONCLUSION

Primary SCLN metastasis in cervical cancer is not incurable. The benefit from PET findings might help in selecting appropriate patients for curative primary and/or salvage treatment.

Aspects of municipal wastewater reclamation and reuse for future water resource shortages in Taiwan

The Water Resources Agency (WRA), Ministry of Economic Affairs (MOEA) has predicted that the annual water demand in Taiwan will reach approximately 20 billion m3 by 2021. However, the present water supply is only 18 billion m3 per year. This means that an additional 2 billion m3 have to be developed in the next 17 years. The reuse of treated wastewater effluent from municipal wastewater treatment plants could be one target for the development of new water resources. The responsible government departments already have plans to construct public sewerage systems in order to improve the quality of life of the populace and protect the environment. The treated wastewater effluent from such municipal wastewater treatment plants could be a very stable and readily available secondary type of water resource, different from the traditional types of water resources. The major areas where reclaimed municipal wastewater can be used to replace traditional fresh water resources include agricultural and landscape irrigation, street cleaning, toilet flushing, secondary industrial reuse and environmental uses. However, necessary wastewater reclamation and reuse systems have not yet been established. The requirements for their establishment include water reuse guidelines and criteria, the elimination of health risks ensuring safe use, the determination of the wastewater treatment level appropriate for the reuse category, as well as the development and application of management systems reuse. An integrated system for water reuse would be of great benefit to us all by providing more efficient ways to utilise the water resources.

Nonvolatile memory devices with NiSi2/CoSi2 nanocrystals

Metal-oxide-semiconductor structures with NiSi2 and CoSi2 nanocrystals embedded in the SiO2 layer have been fabricated. A pronounced capacitance-voltage hysteresis was observed with a memory window about 1 V under low programming voltage. The retention characteristic can be improved by using HfO2 layer as control oxide. The processing of the structure is compatible with the current manufacturing technology of semiconductor industry.

Improving the removal of anions by coagulation and dissolved air flotation in wastewater reclamation

This study investigated the feasibility of improving the removal of anions from a secondary effluent by coagulation/flocculation (Coag/Floc) and dissolved air flotation (DAF) using a pilot-scale wastewater reclamation plant in a high-tech industrial park. The pilot plant was equipped with units of Coag/Floc, DAF, activated carbon beds (AC), microfiltration modules (MF) and a reverse-osmosis membrane (RO). It was operated in-situ continuously for around one year to evaluate the performance of anion removal in two processes - the AC-RO process and the DAF-AC-RO process. Long-term experimental results indicated that combining Coag/Floc, DAF and AC units increased the potential of pretreatment to remove anions. The removal efficiencies in Coag/Floc-DAF units were in the order phosphate > fluoride > chloride > sulfate > silicate. The charged complex of PACl flocs revealed a higher affinity for adsorption onto phosphate and fluoride than on chloride, sulfate and silicate. Comparison of the performance of Coag/Floc-DAF-AC units in the DAF-AC-RO process with that of a single AC unit in the AC-RO process demonstrated that adding Coag/Floc-DAF units increased the removal efficiencies of phosphate, fluoride and silicate by approximately 70.0%, 42.7% and 70.1%, respectively. Most of the phosphate and fluoride were removed in Coag/Floc-DAF units, while most of the silicate escaped from the Coag/Floc-DAF units, and was adsorbed and/or trapped in the AC unit. The quality of reclaimed water in the DAF-AC-RO process complied with the requirements of high-tech industries in cleaning processes. Combined units of Coag/Floc-DAF-AC were therefore recommended for use in pretreatment in wastewater reclamation in high-tech industrial parks.

On-site mercury-contaminated soils remediation by using thermal desorption technology

In this study, the thermal desorption process was used to treat a mercury-contaminated soils in Taipei. A series of bench or pilot plant experiments were also performed the optimized operation condition. The results showed that the concentrations of residual mercury in all treated soils were below 2 mg/kg, some even lower than 0.05 mg/kg. The supernatant and exhaust gas stream of the condensed desorbed mercury vapor in the remediation site were also met with the effluent standard. The total fee was estimated to be US 3,557,000 dollars, when treating contaminated soil leading to a unit treatment cost of US 834 dollars/m3 of soil.

Ovarian endometrioid carcinoma with diffuse pigmented peritoneal keratin granulomas: a case report and review of the literature

The presence of keratin granulomas in peritoneal cavity associated with ovarian endometrioid carcinoma, which might be related to leakage from the ovarian tumor, is rarely reported. Its clinical significance has not yet been well investigated. We report a case presenting with intermittent abdominal pain after an acute episode 1 month before a complex adnexal tumor was noted. Comprehensive cytoreductive surgery was performed. The ovarian tumor was an endometrioid adenocarcinoma with squamous differentiation. There were diffuse brownish flecks over the omental surface and pelvic peritoneum, which contained fragments of degenerated squamous cells, keratin, and numerous foreign body giant cells. Extensive multiple sections were examined for these implants. DNA flow cytometry and various immunostaining studies (HER-2/neu, p53, CK-7, and cytokeratin [AE1/AE3]) were performed. Since viable epithelial cells in the implants could be differentially identified against mesothelial or granulomatous components by CK-7 staining and DNA aneuploidy was demonstrated on primary ovarian tumor, four courses of chemotherapy were administered. The patient has been free of disease for 18 months since diagnosis.

False-positive fluorine-18 fluorodeoxy-D-glucose positron emission tomography imaging caused by retained gauze in a woman with recurrent ovarian cancer: a case report

We report a case of a 47-year-old woman with a false-positive [18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) result caused by retained gauze during resection of liver metastasis for a Stage IV ovarian cancer at primary cytoreductive surgery. She achieved complete remission and remained free of progression for seven years. Owing to elevation of CA-125, computed tomography and PET studies were performed, and both showed two potentially resectable lesions. One was located ventral to the diaphragmatic surface of the left hepatic lobe and the other was around the gauze at the right hepatorenal fossa. During surgical intervention, the left supraheptic tumor was excised and the gauze with surrounding granulation was removed. However, the former proved to be recurrent ovarian cancer with the latter proven false-positive. This case demonstrates that PET results should be interpreted with caution in differentiating a benign inflammatory process from malignant abnormalities, especially in regions with a high probability of granulomatous lesions.

Human papillomavirus genotyping by a polymerase chain reaction-based genechip method in cervical carcinoma treated with neoadjuvant chemotherapy plus radical surgery

The aim of this study was to evaluate the accuracy of human papillomavirus (HPV) genotyping by a polymerase chain reaction (PCR)-based genechip method and to determine the prognostic value of HPV genotype in bulky stage IB or IIA cervical carcinoma treated with neoadjuvant chemotherapy (NAC) and radical surgery. A total of 149 patients had adequate tissue for the study. The SPF1/GP6+ primers were used to amplify a 184 bp fragment. The amplimers were submitted for direct sequencing and hybridization with a genechip using revert-blot detection of 39 types of HPV DNA in a single reaction. Two runs of PCR with respective hybridization were performed for each tumor. The complete concordance of HPV genotyping was 80.5% (120/149) of the paired genechip results. The kappa coefficient was 0.634 (P < 0.0001). HPV DNA sequences were detected in 100% of the specimens, among which 67.8% harbored single type and 32.2% contained multiple types. HPV-16 was detected in 98.7%, HPV-18 in 22.8%, HPV-31 in 0.7%, HPV-45 in 1.3%, HPV-52 in 2.0%, HPV-58 in 6.7%, HPV-59 in 4.7%, and HPV-67 in 0.7%. In multivariate analyses, the HPV genotype [HPV-18 or HPV-16 and HPV-18 only versus all others: relative risk (RR), 2.33; 95% CI, 1.17-4.64; P = 0.016] and pre-NAC tumor size (>5 versus </=5 cm: RR, 2.25; 95% CI, 1.13-4.48; P = 0.021) were significantly related to overall survival. This PCR-based genechip method is sensitive and reproducible for HPV genotyping. The association of HPV-18 or HPV-16 and HPV-18 with poor outcome in cervical carcinoma treated with NAC plus radical surgery is confirmed.

Rapid Identification of Yeasts Commonly Found in Positive Blood Cultures by Amplification of the Internal Transcribed Spacer Regions 1 and 2

A multiplex PCR method using one universal and eight species-specific primers was developed to rapidly identify eight yeast species found in positive blood cultures. The species-specific primers were designed from the internal transcribed spacer regions 1 and 2 of the rRNA gene, whereas the universal primer was located at the 26S rRNA gene. The eight species were Candida albicans, Candida glabrata, Candida guilliermondii, Candida krusei, Candida lusitaniae, Candida parapsilosis, Candida tropicalis, and Cryptococcus neoformans. The PCR products (116 to 630 bp) were different in length and could be effectively separated and recognized by polyacrylamide gel electrophoresis. By testing 234 positive blood cultures (237 isolates), 234 (98.7%) isolates of the above eight species were correctly identified by the multiplex PCR. The present method is simple to perform and can be completed within 6 h.

Fatal herpes simplex infection in a pygmy African hedgehog (Atelerix albiventris)

An adult pygmy African hedgehog developed acute posterior paresis attributed to a prolapsed intervertebral disc diagnosed by C-T scan. Corticosteroid therapy resulted in prompt resolution of the ataxia, but 2 weeks later the animal became anorexic and died. Macroscopically, the liver was stippled with punctate off-white foci which were confirmed microscopically to be foci of necrosis. Numerous hepatocytes contained intranuclear inclusions and syncytial cell formation was also present. A herpes virus was isolated and identified by fluorescent antibody and polymerase chain reaction studies as herpesvirus simplex type 1. To our knowledge, this is the first report of herpes infection in the African hedgehog and the first time herpes simplex has been identified as a cause of disease in insectivores.

Thyroid Doppler ultrasonography and resistive index in the evaluation of the need for ablative or antithyroid drug therapy in Graves' hyperthyroidism

BACKGROUND AND PURPOSE

Graves' disease (GD) is the most common hyperthyroid disorder, but the therapeutic strategy for choosing between medical or ablative therapy has not been standardized. Thyroid hypervascularity is an important diagnostic feature in GD. This study collected Doppler ultrasonography data from patients with GD, Hashimoto's thyroiditis, and simple goiter to develop a hemodynamic index for use in the evaluation of when antithyroid drugs (ATDs) should be withdrawn or ablative therapy given in GD.

MATERIAL AND METHODS

Thyroid Doppler ultrasonography was used to measure the resistive index (RI) and pulsatility index (PI) in various thyroid diseases. We studied 88 patients, including 13 untreated GD patients, 14 euthyroid GD patients after withdrawal of ATDs for more than 12 months, 14 euthyroid GD patients with normal thyroid stimulating hormone (TSH) concentrations after regular ATD treatment for 12 months (well controlled), 16 hyperthyroid GD patients with undetectable TSH concentrations after regular ATD treatment for more than 12 months (poorly controlled), 13 Hashimoto's thyroiditis patients, and 18 patients with simple goiters.

RESULTS

The PI and RI were significantly different between patients with untreated (median PI/RI 1.36/0.79) or medically well-controlled (median PI/RI 0.66/0.51) GD, but no significant differences in PI and RI were found between patients with untreated or medically poorly controlled (median PI/RI 1.24/0.74) GD. An RI cut-off of at least 0.7 with undetectable TSH was found to be suggestive of the need for ablative therapy in GD patients who had received regular ATD treatment for more than 12 months, because of its statistically high sensitivity and specificity in all untreated and poorly controlled GD patients. An RI of less than 0.6 with normal TSH was suggestive of the need for withdrawal of ATDs in GD patients receiving regular medical treatment, because of its statistically high sensitivity and specificity in all treated euthyroid GD patients.

CONCLUSIONS

This study has developed an RI-derived hemodynamic index that determines the need for ablative or ATD therapy in patients with GD. A large-scale, prospective study is needed to confirm its clinical value.

Three-dimensional cytomorphology in fine needle aspiration biopsy of medullary thyroid carcinoma

OBJECTIVE

To elucidate three-dimensional (3-D) cytomorphology in fine needle aspiration biopsy (FNAB) of medullary thyroid carcinoma (MTC).

STUDY DESIGN

ENAB was performed on tumors from five patients with MTC. The aspirate was stained and observed under a light microscope (LM). The aspirate was also fixed, dehydrated, critical point dried, spattered with gold ions and observed with a scanning electron microscope (SEM). For transmission electron microscopy (TEM), the specimen was fixed, dehydrated, embedded in an Epon mixture, cut with an ultramicrotome, mounted on copper grids, electron doubly stained with uranium acetate and lead citrate, and observed with TEM. Findings under SEM were correlated with those under LM and TEM.

RESULTS

Under SEM, 3-D cytomorphology of MTC displayed a disorganized cellular arrangement with indistinct cell borders in three cases. The cell surface was uneven and had granular protrusions that corresponded to secretory granules observed under TEM. In one case with multiple endocrine neoplasia type IIB, there were abundant granules on the cell surface. In one case of sporadic MTC with multinucleated tumor giant cells and small cells, granular protrusions also were noted on the cell surface.

CONCLUSION

Granular protrusion was a characteristic finding in FNAB of MTC tinder SEM and might be helpful in the differential diagnosis.

Effect of prolonged radiation exposure on the thyroid gland of residents living in 60Co-contaminated rebar buildings

PURPOSE

To evaluate prolonged low dose-rate gamma-exposure effects on the thyroid glands of residents living in 60Co-contaminated steel buildings.

MATERIALS AND METHODS

Physical examination and ultrasonography of the thyroid, determination of thyroid function and anti-thyroid microsomal antibodies were performed for 1346 residents. Ultrasound-guided aspiration cytology was done for thyroid nodules. The study subjects were stratified by age at examination (< or = 15 and > 15 years), sex and exposure dose to the body. Dose-response data on the prevalence of various thyroid diseases were analysed by the multiple logistic regression analysis.

RESULTS AND CONCLUSIONS

The prevalence of simple goitre was related to the exposure with a dose-response relationship for males of all ages, and for females of < or = 15 years. There was a biological gradient of thyroid cyst prevalence with the increase in exposure dose for females of all ages. The prevalence of elevated serum tri-iodothyronine level showed a dose-response relationship for males of < or = 15 years. A significant increase in thyroid abnormalities with dose was observed for males of all ages, and for females of < or = 15 years.

Intralesional injection for hepatic metastasis from cervical carcinoma. A report of two cases

BACKGROUND

The treatment of isolated hepatic metastasis from carcinoma of the uterine cervix has yet to be established. We tested the efficacy of percutaneous injection of ethanol and acetic acid as a curative-intent treatment modality for this rare event.

CASES

Under real-time sonographic guidance, two patients with a solitary hepatic metastasis from carcinoma of the cervix were treated with 99.5% percutaneous ethanol injection (one patient) and 50% percutaneous acetic acid injection (the other patient). The treatment was repeated weekly if laboratory data permitted and aspiration cytology interpreted on site showed tumor cells. Cytology after complete treatment showed no residual tumor cells in either case. Both patients had no evidence of disease during follow-up for 12 and 24 months, respectively.

CONCLUSION

Treatment was successful in two patients with isolated hepatic metastatic lesions from carcinoma of the cervix who received percutaneous injection of 99.5% ethanol or 50% acetic acid.

Rapid identification of yeasts in positive blood cultures by a multiplex PCR method

Yeasts are emerging as important etiological agents of nosocomial bloodstream infections. A multiplex PCR method was developed to rapidly identify clinically important yeasts that cause fungemia. The method amplified the internal transcribed spacer 1 (ITS1) region between the 18S and 5.8S rRNA genes and a specific DNA fragment within the ITS2 region of Candida albicans. With this method, C. albicans produced two amplicons, whereas other species produced only one. Through sequence analysis, the precise lengths of the PCR products were found to be as follows: C. glabrata (482 or 483 bp), C. guilliermondii (248 bp), C. parapsilosis (229 bp), C. albicans (218 or 219 and 110 bp), C. tropicalis (218 bp), Cryptococcus neoformans (201 bp), and C. krusei (182 bp). The PCR products could be effectively separated by disk polyacrylamide gel electrophoresis. The method was used to test 249 positive blood cultures (255 isolates), from which the following species (strain number) were isolated: C. albicans (128), C. tropicalis (51), C. glabrata (28), C. parapsilosis (23), C. neoformans (9), C. krusei (5), C. guilliermondii (3), and other, minor species (8). The test sensitivity of the method was 96.9% (247 of 255 isolates). The eight minor species were either misidentified (one strain) or not identified (seven strains). From the time at which a positive bottle was found, the multiplex PCR could be completed within 8 h; the present method is simpler than any previously reported molecular method for the identification of blood yeasts.

Isolated paraaortic lymph node recurrence after definitive irradiation for cervical carcinoma

PURPOSE

To evaluate the clinical features of isolated paraaortic lymph node (PALN) recurrence after definitive radiotherapy, and analyze the prognostic factors and effect of salvage treatment.

METHODS AND MATERIALS

Of a total 876 patients who received pelvic radiotherapy after the diagnosis of primary cervical carcinoma, 26 were found to have isolated PALN recurrence as the first recurrent site, and these patients enrolled in this study. Only those with primary-site carcinoma controlled and who were free of other distant metastases were eligible. Nineteen of the 26 patients accepted salvage therapy. Fourteen patients accepted concurrent chemoradiation (CCRT), 1 accepted radiation to the paraaortic region, and 4 accepted chemotherapy alone. Clinical parameters evaluated included tumor markers (SCC and CEA) and image studies.

RESULTS

Seven of the 26 patients were alive and disease-free. All 7 survivors had salvage treatment with radiation to the paraaortic region and concurrent cisplatin-based chemotherapy. None of the patients receiving chemotherapy or radiation alone enjoyed long-term, disease-free survival. The 5-year survival rate for isolated PALN recurrence of the 14 patients who accepted salvage concurrent chemoradiation (CCRT) was 51.2%. The presence of a clinical symptom at the time of PALN recurrence was analyzed. Seven of the 12 asymptomatic patients and none of the 14 symptomatic patients survived without disease after salvage treatment. The SCC levels at recurrence showed a statistically significant relationship to disease-free survival.

CONCLUSIONS

An SCC level of < or = 4 ng/ml and a lack of symptoms at the time of recurrence were good prognostic factors in isolated PALN recurrence after primary radiation therapy. In addition to concurrent CCRT, periodical surveillance with tumor markers and imaging studies allowed early detection and salvage of those patients.

Intraarterial lidocaine for pain control after uterine artery embolization for leiomyomata

PURPOSE

To evaluate the effectiveness of intraarterial lidocaine in controlling pain after uterine artery embolization (UAE).

MATERIALS AND METHODS

In this double-blind prospective study, patients undergoing UAE received preservative-free 1% lidocaine or saline solution (control) in the uterine arteries before embolization. Postprocedural pain was managed with patient-controlled intravenous morphine. Attempted doses, number of doses received, total morphine dose, and maximum pain numeric rating scale (NRS) score during the postprocedural hospitalization were recorded and compared. Three-month follow-up magnetic resonance (MR) imaging and symptomatic questionnaires were collected and compared.

RESULTS

Ten patients received lidocaine and eight patients received placebo. Moderate to severe vasospasm was noted in seven patients after lidocaine injection, whereas no vasospasm was noted in the placebo group (P =.004). Patients in the lidocaine group had lower NRS pain scores than those in the placebo group (P =.012), whereas there was no difference in morphine requirement between treated patients and control subjects. The study was terminated after 18 patients were treated as a result of unexpected vasospasm.

CONCLUSIONS

Intraarterial 1% lidocaine is associated with moderate to severe vasospasm. Lidocaine significantly lowers subjective pain, but there is no difference in analgesic requirements. The routine use of intraarterial lidocaine is not recommended for pain control until the long-term effects of vasospasm on outcome is known.

Thyroidectomy or radioiodine? The value of ultrasonography and cytology in the assessment of nodular lesions in Graves' hyperthyroidism

Although diffuse toxic goiter is a classical feature of Graves' disease (GD) nodular goiters are occasionally found in some patients. The aim of the present study was to investigate the ultrasonographic and corresponding cytological manifestations in GD patients with nodular lesions to decide on a therapeutic strategy. Twenty-seven consecutive GD patients with nodular goiter were included in this study (21 women and six men, mean age 41.2 years, range 22-77 years). All underwent thyroid ultrasonography and fine-needle aspiration cytology. Of the 27 patients eight underwent surgical intervention because papillary thyroid carcinoma or follicular neoplasm was diagnosed by cytology; five of these were shown to have papillary thyroid carcinomas. Ultrasonography revealed the malignant nodules to be hypoechogenic, heterogeneous, and with ill-defined margins in four of these five thyroid cancers, whereas the remaining sonogram showed a cystic change and cauliflower-like tumor formation with microcalcification. The volume and maximal diameter of cancerous nodules were significantly larger than those of benign nodules. In conclusion our results reveal that ultrasonography and fine-needle aspiration cytology are reliable and quick methods for diagnosing nodular goiters in GD patients. If thyroid neoplasms are found ablative therapy with thyroidectomy is indicated instead of radioactive iodine.

Diagnostic pitfalls of fine-needle aspiration cytology and prognostic impact of chemotherapy in thyroid lymphoma

BACKGROUND AND PURPOSE

Fine-needle aspiration cytology (FNAC) is an important method in the evaluation of goiter. However, difficulties are encountered when using this technique to distinguish Hashimoto's thyroiditis from thyroid lymphoma. This study sought to determine the diagnostic sensitivity of FNAC and to determine the effectiveness of chemotherapy in the treatment of thyroid lymphoma.

METHODS

We retrospectively reviewed the clinical manifestations, diagnostic methods, treatment, and prognosis in 14 consecutive patients with histopathology-verified thyroid lymphoma treated in National Taiwan University Hospital from 1981 to 2000.

RESULTS

Eleven of the 14 patients underwent FNAC, which identified six lymphomas, one anaplastic carcinoma, three cases of Hashimoto's thyroiditis, and one case of Riedel's struma. Because all cases were promptly biopsied, the mean survival times for patients with or without the correct initial diagnosis (15 mo vs 43 mo) did not differ significantly (p = 0.098 by Student's t-test). Thyroid lymphoma was diagnosed before 1990 in four patients, three of whom were treated with local radiotherapy and one with surgical resection. The mean survival time of these four patients was 60 days. Thyroid lymphoma was diagnosed after 1990 in 10 patients, nine of whom underwent systemic chemotherapy, with additional adjunctive radiotherapy in three patients. The mean survival time in the nine of these 10 patients with follow-up was 60 months. A significant difference was found in the mean disease-free survival times between patients treated before and after 1990 (60 d vs 60 mo, p = 0.005).

CONCLUSIONS

In this study, FNAC had a sensitivity of only 55%, its major limitation being misdiagnosis of lymphoma as Hashimoto's thyroiditis in three patients. However, such initial misdiagnosis does not affect the prognosis if promptly corrected by histopathology. As evidenced by the improved survival of patients receiving chemotherapy after 1990, we conclude that chemotherapy is effective in the treatment of thyroid lymphoma.

The effect of mutating arginine-469 on the substrate binding and refolding activities of 70-kDa heat shock cognate protein

On the basis of the X-ray structure of DnaK, we obtained an energy-minimized model for the C-terminal domain of rat 70-kDa heat shock cognate protein (hsc70). The model suggests that Arg-469 may play an important role in maintaining the substrate-bound conformation of hsc70. To verify this hypothesis, we substituted cysteine for Arg-469 and generated the hsc70(R469C) mutant. Compared to the wild-type hsc70, the mutant was more accessible to cleavage by endopeptidase Lys-C, implying that the overall structure of hsc70(R469C) is relatively loose. Moreover, hsc70(R469C) did not form tightly associated complexes with S-carboxymethyl-alpha-lactalbumin, an unfolded protein. The amount of heptapeptide FYQLALT bound to hsc70(R469C) was also decreased as determined by gel filtration. Thus, the affinity of hsc70(R469C) for polypeptide substrates is reduced. In the presence of DnaJ, the capability of hsc70(R469C) to refold the denatured luciferase was decreased by 50%. Therefore, for hsc70, reduction in affinity for substrates may affect its DnaJ-dependent refolding activity.

Differential regulation of placental and germ cell alkaline phosphatases by glucocorticoid and sodium butyrate in human gastric carcinoma cell line TMK-1

The expression and regulation of alkaline phosphatase (AP) was studied in the human gastric cancer cell line TMK-1. Biochemical analysis, reverse transcription-polymerase chain reaction, and Northern blot analysis demonstrated that the cells express placental, germ cell, and intestinal AP isozymes constitutively. Dexamethasone (Dex), a synthetic glucocorticoid, was shown to specifically induce the placental AP activity to about 10-fold and sodium butyrate (NaBu) induced germ cell AP activity to about 4-fold, respectively. In contrast, these two agents showed little effect on the level of intestinal isozymes. Dex and NaBu also differentially induced the mRNA levels of the placental and germ cell APs. Northern blot analysis of the placental AP transcript in the presence of the transcription inhibitor, 5, 6-dichloro-1-beta-D-ribofuranosyl benzimidazole, revealed that the half-life of placental AP mRNA is about 27 h for both the Dex-treated and untreated cells. Nuclear run-on transcription analysis indicated an apparent increase in the rate of placental AP gene transcription in Dex-treated cells. These results indicated that the effect of Dex occurred primarily by activation of the placental AP gene transcription in the cells. In order to study the direct Dex and NaBu effect on AP gene expression, the proximal promoter regions of AP genes were fused to luciferase reporter vectors. Despite the high similarity in nucleotide sequences of these two genes, transient transfection analysis demonstrated that Dex and NaBu exerted a specific stimulation only through the respective placental and germ cell AP gene promoter. Taken together, this study indicates that the expression of PAP and GCAP isozymes have specific regulatory mechanisms that can be differentially controlled by signals including glucocorticoid and NaBu.

Evaluation of Etest for direct antifungal susceptibility testing of yeasts in positive blood cultures

The performance of the Etest (AB BIODISK, Solna, Sweden) for direct antifungal susceptibility testing of yeasts in positive blood cultures was compared with that of the macrodilution method for determining the MICs of five antifungal agents. Culture broths with blood from bottles positive for yeasts were inoculated directly onto plates for susceptibility testing with the Etest, and the MICs were read after 24 and 48 h of incubation. A total of 141 positive blood cultures (72 cultures of Candida albicans, 31 of Candida tropicalis, 14 of Candida glabrata, 11 of Candida parapsilosis, 3 of Candida krusei, and 3 of Cryptococcus neoformans, 4 miscellaneous yeast species, and 3 mixed cultures) were tested, and the rates of MIC agreement (+/-1 log(2) dilution) between the direct Etest (at 24 and 48 h, respectively) and macrodilution methods were as follows: amphotericin B, 81.8 and 93.5%; flucytosine, 84.8 and 87.7%; fluconazole, 89.4 and 85.5%; itraconazole, 69.7 and 63.8%; ketoconazole, 87.9 and 79.0%. By a large-sample t test, the difference in log(2) dilution between the direct Etest and the macrodilution method was found to be small (P < 0.05). The lone exceptions were ketoconazole at 48 h of incubation and itraconazole at both 24 and 48 h of incubation (P > 0.05). By Tukey's multiple comparisons, the difference between the direct Etest (48 h) and reference methods among different species was found to be less than 1 log(2) dilution. When the MICs were translated into interpretive susceptibility, the minor errors caused by the direct Etest (at 24 and 48 h, respectively) were as follows: flucytosine, 2.3 and 1.4%; fluconazole, 3.0 and 3.6%; itraconazole, 21.2 and 21.3%. Itraconazole also produced an additional 3.0 and 3.6% major errors as determined by the direct Etest at 24 and 48 h, respectively. It was concluded that, except for itraconazole, the Etest method was feasible for direct susceptibility testing of blood cultures positive for yeasts. The method is simple, and the results could be read between 24 and 48 h after direct inoculation, whenever the inhibition zones were discernible.

Rapid identification of Bacillus cereus based on the detection of a 28.5-kilodalton cell surface antigen

Conventional procedures for the identification of suspect Bacillus cereus isolated on mannitol-egg yolk-polymyxin (MYP) agar may need several days. To facilitate the identification of the bacterium, an enzyme-linked immunosorbent assay (ELISA) was developed. The assay was based on the detection of a 28.5-kDa cell surface antigen of B. cereus. Bacterial colonies grown on MYP agar or nutrient agar were suspended in phosphate-buffered saline (pH 7.2) containing 0.1% Teepol. The cell suspensions were heated at 100 degrees C for 5 min and added to the microtiter plates coated with antibodies against the 28.5-kDa antigen. After washing, the same antibodies labeled with horseradish peroxidase were used as secondary antibodies to reveal the signal of antigen-antibody reaction. For 38 strains of B. cereus and 127 strains of non-B. cereus bacteria (including 79 isolates of Bacillus spp.) tested, the sensitivity and specificity of the ELISA were 100 and 88.2%, respectively. Strains producing false-positive results were members of the B. cereus group (i.e., Bacillus anthracis, Bacillus mycoides, and Bacillus thuringiensis), which are genetically and biochemically similar to B. cereus. Similar ELISA results were obtained by using antibodies against another cell surface antigen with a molecular mass of 20 kDa. If members of the B. cereus group were recognized as a single species, the sensitivity and specificity of the ELISA were 100 and 99.1%, respectively. The ELISA could be used as a rapid method for presumptive identification of B. cereus grown on MYP agar.

Thickened pituitary stalk with central diabetes insipidus: report of three cases

Diabetes insipidus of central origin usually results from lesions in the hypothalamic neurohypophyseal system. Lymphocytic infundibuloneurohypophysitis is an uncommon cause. Cases of lymphocytic infundibuloneurohypophysitis with thickening of the pituitary stalk and enlargement of the neurohypophysis with no hyperintense signal in the posterior pituitary have been reported. Reported cases presenting with isolated thickening of the pituitary stalk are very rare. We report three such cases, one in a nulliparous woman and the other two in men. Magnetic resonance (MR) imaging in these patients revealed isolated thickening of the pituitary stalk, loss of the hyperintense signal of the posterior pituitary, and an adenohypophysis of normal size. All cases had abnormal nodular infundibular enlargement. One male patient had hypogonadism; the other patients showed no sign of adenohypophyseal deficiency on stimulation test. Serial follow-up MR imaging revealed that all three patients had persistent thickening of the pituitary stalk. Diabetes insipidus was controlled by the administration of desmopressin acetate in all patients.

Cerebellar metastasis from papillary serous adenocarcinoma of the ovary mimicking Ménière's disease. A case report

BACKGROUND

In rare cases, cerebellar metastasis originating in serous papillary adenocarcinoma of the ovary can mimick Ménière's disease.

CASE

A 51-year-old woman, with complete remission after optimal maximal debulking and chemotherapy for an International Federation of Gynecology and Obstetrics IIIc primary ovarian carcinoma, presented with nausea, vomiting, vertigo and headache 18 months after surgery. Investigations revealed a solitary cerebellar cystic mass, 4.6 x 4.0 x 3.2 cm. Gross total excision of the cerebellar lesion followed by brain irradiation resulted in complete resolution of her symptoms. Histology showed a metastatic tumor consistent with the primary ovarian carcinoma.

CONCLUSION

In an atypical presentation in patients with metastatic ovarian carcinoma, thorough investigations should be done to rule out or confirm brain metastasis, which can be aggressively managed to prevent serious consequences and improve outcome.