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Biomedical subjects

M F Chen

Publications and source records attributed to M F Chen.

At least 415 records · Page 23Linked to original sources

Genetic alternations of p73 are infrequent but may occur in early stage hepatocellular carcinoma.

p73, a structural homologue of the tumor suppressor gene, p53, has recently been identified and mapped to chromosome 1p36, where genomic loss of heterozygosity (LOH) often occurs in human hepatocellular carcinoma (HCC). To determine whether p73 is involved in the development of HCC and whether there is an inverse correlation between the mutations of p73 and p53, we examined 22 paired tumors/noncancerous liver tissues for allelic expression, LOH and mutation of p73 and for mutation of p53. p73 was biallelically expressed in noncancerous liver tissues and in 7 out of the 8 informative tumors. One tumor tissue expressed only a single allele. LOH of p73 was found in 2 out of the 11 (18%) informative cases. A tumor-specific five-nucleotide deletion mutation causing a reading frameshift/early truncation of p73 DNA-binding domain was found, in which case no concomitant mutation in the DNA-binding domain of p53 was identified. Nine out of the 22 cases (41%) contained tumor-specific mutations in the DNA-binding domain of p53. Two of the three cases with p73 genetic alternations had a tumor size of less than 2 centimeters. These results suggest that p73 is a biallelically expressed gene in the liver and that allelic loss and mutation of p73 is infrequent and may occur early in HCC. p73 is unlikely to be the putative tumor suppressor gene located at chromosome 1p36 in HCC.

Adult↗

p16INK4 gene mutation and allelic loss of chromosome 9p21-22 in Taiwanese hepatocellular carcinoma.

BACKGROUND: The p16INK4 (MTS1/CDNK2A) gene, located on chromosome 9p21, is an inhibitor of cyclin-dependent kinase 4. Various data have shown that it is frequently inactivated in several types of cell lines and primary human cancers. MATERIALS AND METHODS: Thirty cases with hepatocellular carcinoma were studied for possible p16INK4 gene mutation in Taiwan. Homozygous deletion was determined using polymerase chain reaction (PCR). The p16INK4 gene mutation was first screened by single strand conformation polymorphism, then direct DNA sequencing was performed on the cases with mobility shifts. Deletion mapping of chromosome 9p21-22 was also carried out with two polymorphic microsatellite markers (D9S925 and D9S168) using PCR. RESULTS: One of the 30 cases had homozygous deletion at exon 3 of the p16INK4 gene. Another tumor had altered electrophoresed mobility in exon 2 with G to T transversion in the first nucleotide of codon 61 by direct sequencing causing a stop codon (GAG-->TAG). At the D9S925 and D9S168 loci, six out of 24 (25%) and three out of 19 (16%) informative cases showed loss of heterozygosity, respectively. CONCLUSION: Point mutation and homozygous deletion of the p16INK4 gene are present in a subset of hepatocellular carcinomas in Taiwan. The patterns of the p16INK4 gene alteration are, however, different from those from other regions. In addition, allelic loss on chromosome 9p21-22 is not an uncommon event in hepatocellular carcinomas. Therefore, the significance of chromosome 9p loss deserves to be extensively investigated.

Adult↗

Prospective and randomized study of gabexate mesilate for the treatment of severe acute pancreatitis with organ dysfunction.

BACKGROUND/AIMS: Exaggerated production of various proteases may account for the late presence of organ dysfunction in acute pancreatitis. This study examined the effects of early administration of gabexate mesilate on the condition of patients with severe acute pancreatitis and organ dysfunctions. METHODOLOGY: Fifty-two patients with acute pancreatitis and organ dysfunction were enrolled. The treatment group included 26 patients receiving intravenous gabexate mesilate infusion at a dose of 100 mg/hr for 7 days. APACHE-II score, clinical and biochemical parameters were monitored intensively. RESULTS: Coagulopathy ileus, and abdominal pain was significantly improved with gabexate mesilate. Gabexate mesilate reduced the necessity for surgical intervention and peritoneal lavage. The 7-day-mortality and 90-day-mortality rates were also significantly reduced with gabexate mesilate therapy. CONCLUSIONS: There are strong indications from this study that early intravenous gabexate mesilate infusion results in improved survival in acute pancreatitis with organ dysfunctions.

Adult↗

Common bile duct and pancreatic injury after extracorporeal shock wave lithotripsy for renal stone.

Common bile duct and pancreatic injury are rare complications following extracorporeal shock wave lithotripsy. We reported a case of peripancreatic abscess with inflammation change of common bile duct and pancreatic head following extracorporeal shock wave lithotripsy for right renal stone. Its anatomical location and subsequent clinical course suggest it was related to trauma caused by the shock wave. It should be considered a relative contraindication to apply extracorporeal shock wave lithotripsy in cases of right renal stone associated with large gall stones.

Aged↗

Surgery for chronic obstructive pancreatitis: comparison of end-to-side pancreaticojejunostomy with pancreaticoduodenectomy.

BACKGROUND/AIMS: Chronic obstructive pancreatitis usually manifests with intractable pain and recurrent episodes of chronic pancreatic inflammation. The side-to-side pancreaticojejunostomy is used for those patients with a large pancreatic duct. But for the patients with small pancreatic duct, the optimal surgical procedure needs to be evaluated. A prospective study was designed to compare the different results between distal pancreatectomy plus end-to-side pancreaticojejunostomy and pancreaticoduodenectomy. METHODOLOGY: The patients were chosen prospectively and randomly to undergo either a distal pancreatectomy plus end-to-side pancreaticojejunostomy or pancreaticoduodenectomy in the last 3 years. Eighteen patients with chronic obstructive pancreatitis were randomly divided into two groups. Ten patients (group A) underwent distal pancreatectomy plus end-to-side and ductal to mucosal pancreaticojejunostomy, and the other 8 patients (group B) underwent pancreaticoduodenectomy were compared. RESULTS: The operative time was significantly shorter and operative blood loss was less in group A. The postoperative follow-up of patients in group A had better outcome with increased body weight and no steatorrhea or diabetes mellitus, and all of them had complete pain relief. CONCLUSIONS: We concluded that distal pancreatectomy with end-to-side pancreaticojejunostomy provided a better surgical treatment for the patients with chronic obstructive pancreatitis and small pancreatic duct.

Adult↗

Surgical treatment of pancreatic vasoactive intestinal polypeptide-secreting tumor: a case report.

A 68-year-old woman presented with secretory watery diarrhea causing hypokalimia, hypoalbuminemia and dehydration for 5 years. Subsequent investigations including abdominal ultrasonography and computed tomography scanning revealed a mass measuring 7 x 6 cm in the pancreatic tail. The diagnosis of pancreatic VIPomas was suspected on the basis of clinical symptoms. The patient underwent distal pancreatectomy and splenectomy after resuscitation of electrolyte imbalance, dehydration and malnutrition. The pathological examination with histoimmunochemical stain confirmed the diagnosis. Postoperative course is uneventful and the patient does not have symptoms any longer during the follow-up period.

Aged↗

Chronic pancreatitis with pancreas divisum treated with pylorus-preserving pancreatoduodenectomy: a case report.

Pancreas divisum, the most common congenital variant of pancreatic ductal anatomy, occurs when the ventral and dorsal pancreatic-buds fail to fuse. Herein, we report on a 42-year-old male suffering from chronic pancreatitis with pancreas divisum. Magnetic resonance cholangiopancreatography confirmed this diagnosis. A pylorus-preserving pancreatoduodenectomy was then performed. Pathological examination of the pancreas demonstrated chronic pancreatitis without malignancy. The postoperative clinical course was uneventful, and the patient was discharged 10 days after surgery.

Adult↗

Peripheral cholangiocarcinoma with thoracic spine metastasis: a successful surgically treated case.

In this study we present a rare case of cholangiocarcinoma with metastasis to the thoracic spine. A 63-year-old female with peripheral cholangiocarcinoma associated with hepatolithiasis presented low back pain as a result of a thoracic spine (T12) compression fracture. Spine surgery and pathological examination revealed a metastatic mucinous adenocarcinoma of unknown origin. Two weeks after the spine surgery, a nontender palpable abdominal mass was found at the epigastric area. Abdominal sonography (US), abdominal computed tomography (CT), and magnetic resonance cholangiopancreaticogram (MRCP) revealed a hepatic tumor, hepatolithiasis, and gallbladder empyema. The patient underwent hepatic resection, cholecystectomy, and choledocholithotomy with T-tube stent. Pathological examination with immunohistochemical stain revealed hepatolithiasis concurrent with mucinous cholangiocarcinoma. Postoperative course was uneventful and no recurrence was noted during a 1-year follow-up period.

Bile Duct Neoplasms↗

Hepatic resection for 28 patients with small hepatocellular carcinoma.

Twenty-eight patients with hepatocellular carcinoma (HCC) of not larger than 5 cm diameter were surgically treated during the 12 years from 1977 to 1988, twenty-five of them since 1983. Half of the patients were admitted for check up because of elevated serum AFP and were high risk subjects. Serum HBsAg were positive in 24 (85.7%). Serum AFP was less than 10 ng/ml in 2 (7.1%) and greater than or equal to 200 ng/ml in 14 (50%). Coexistent liver cirrhosis was found in 21 (75%). Local resection or partial hepatectomy played a major surgical role in small HCC, especially in the presence of cirrhosis and tumor in right liver. The cumulative survival rates for the 28 patients treated by hepatic resection at 1, 2 and 5 years were 60.6, 42.5 and 42.5 percent. The survival rate of patients with tumor size not larger than 3 cm diameter is not better than those with tumor size between 3 cm and 5 cm. The small HCC patients with AFP less than or equal to 200 ng/ml had better survival than those with AFP greater than 200 ng/ml.

Adolescent↗

Induction of murine lymphokine-activated killer-like cells by Corynebacterium parvum (C. parvum) in vitro: lysis of tumor cells and macrophages by C. parvum-induced killer cells.

In vitro culture of murine spleen cells with Corynebacterium parvum (C. parvum) was found to induce lymphokine-activated killer (LAK)-like cells capable of killing both natural killer (NK)-sensitive and NK-resistant tumor cells as well as syngeneic macrophages (M phi). The induction of LAK-like activity by C. parvum was significantly inhibited by anti-interleukin-2 (IL-2) or anti-interferon (IFN) alpha, beta antibody (Ab), and it was further inhibited by the combination of two Abs, suggesting that the generation of killer cells by C. parvum was dependent on IL-2 and IFN(s) produced in the culture. It was considered that M phi were important in the induction of LAK-like cells by C. parvum because the depletion of M phi from spleen cells before culture with C. parvum significantly reduced the induction of killer activity. The majority of effectors mediating both tumor cells and M phi were Thyl+ and asialo-GM1 (aGM1)+, and the lysis of M phi by C. parvum-induced killer cells could be inhibited by the addition of cold YAC-1 tumor cells and P815 tumor cells, suggesting that the same population of effectors recognized tumor cells and M phi. These results demonstrated a possibility that the killing of M phi by C. parvum-induced killer cells might down-regulate anti-tumor effects of C. parvum.

Animals↗

Percutaneous transhepatic biliary drainage for acute cholangitis.

Percutaneous Transhepatic Biliary Drainage (PTHBD) was performed in 56 consecutive patients with severe acute cholangitis, during a period of one year. An immediate decompression effect with a "good" response was achieved in 46 (82.2%), who usually became afebrile within 18 to 24 hours, and "poor" response in 10 (17.8%). Five died (8.93%) in a subsequent operation. No mortality was associated with the use of PTHBD. Complications related to the procedure occurred in 12 of the 56 patients (21.4%). Hemobilia was the major complication. The other complications were intraabdominal hemorrhage, bleeding from the puncture site, transient hypotension, catheter occlusion and/or dislodgement, bile leak, pneumothorax and hemothorax. Two with hemobilia, one with intraabdominal hemorrhage and the other with bile leak required an emergency operation. PTHBD procedures can be lifesaving in biliary sepsis. Once infection and hyperbilirubinemia are controlled, rational subsequent therapy can be formulated for the underlying disease.

Acute Disease↗

5-Fluorouracil cytotoxicity in human colon HT-29 cells with moderately increased or decreased cellular glutathione level.

Little is known whether diet or certain components in the diet can modulate the efficacy of 5-fluorouracil (5FU) in patients with colon carcinoma. Glutathione (GSH), an important antioxidant and anticarcinogen, is present in many foods in varying amounts. This study examined whether a moderately increased or decreased cellular GSH level had any effect on the growth of human colon adenocarcinoma cells HT-29 and on the cytotoxic activity of 5FU in these cells. GSH and buthionine sulfoximine were used to enhance or reduce the GSH level respectively in these cells. A 34% increase in cellular GSH level had no effect on the growth of HT-29 cells, nor on the cytotoxic activity of 5FU as determined by the MTT colorimetric assay and cell counts. A 50% reduction in the cellular GSH level was found to enhance 5FU cytotoxicity by 20% to 31% as determined by the MTT colorimetric assay, depending on the 5FU concentration. This study shows that a moderate change in the GSH level in HT-29 cells had little or no effect on the cells' growth, but a decrease in cellular GSH level slightly enhanced the cytotoxic activity of 5FU in these cells.

Adenocarcinoma↗

Balloon dilatation of intrahepatic duct and biliary-enteric anastomosis strictures. Long term results.

From June 1984 to December 1986, 13 patients with 15 benign bile duct strictures were treated by Gruntzig balloon dilatation via the T-tube fistula or transhepatic route. The patients were 7 men and 6 women; ages ranged from 24 to 63 years old. The site of strictures were hepatojejunostomy in six, right intrahepatic duct in 4, left intrahepatic duct in 4 and one choledochoduodenostomy. Eleven out of 13 patients with bile duct strictures had intrahepatic stones. Ninety-three percent (14/15) of the strictures were successfully dilated by the Gruntzig balloon catheter. After the biliary stent was inserted for 2 to 6 months, follow-up cholangiogram or choledochoscopy revealed good patency of the biliary tree. Ninety-one percent (10/11) of the intrahepatic stones were removed completely by choledochoscopy. No major complication was found during balloon dilatation, except tolerable wound pain. Five patients (45%) developed symptoms during the follow-up period of 5 to 7 1/2 years. Two patients complained of right upper quadrant (RUQ) pain and 3 patients developed acute cholangitis which was treated by percutaneous biliary drainage again or laparotomy. Balloon dilatation for biliary-enteric anastomosis and intrahepatic duct strictures is a non-surgical, simple and effective procedure, but the incidence of restenosis rate is high and up to 45% within a long-term follow-up period of 5 to 7 1/2 years.

Adult↗

Circumferential suture technique for esophageal transection to treat esophageal variceal bleeding.

The EEA stapler has been used routinely for esophageal transection to treat esophageal variceal bleeding for some time. It carries the risk of postoperative leakage and is not suitable in those cases receiving recent sclerotherapy. The circumferential suture technique presented in this paper can be used in any situation requiring esophageal transection. It has been utilized by us in twenty-two emergent cases with good results.

Combined Modality Therapy↗

Secural pancreaticojejunal anastomosis for the pancreaticoduodenectomy.

BACKGROUND/AIMS: This report presents the results of two methods for minimizing complications following a Whipple operation. MATERIALS AND METHODS: In the past five years, continuous duct to mucosal suture with end to side anastomosis of the pancreaticojejunostomy was utilized in 30 patients. Another 50 patients received interrupted duct to mucosal suturing with end to side anastomosis of the pancreaticojejunostomy in the past five to ten years. RESULTS: None of the first set of 30 patients suffered leakage after the operation. Ten of the 50 patients (20%) developed leakage postoperatively and 3 (6%) died. The group with continuous duct to mucosal suture had significantly less complications than those with interrupted duct to mucosal suturing (P < 0.05). Late follow up of the patients with continuous duct to mucosal suture using echogram, no one had stricture of the anastomosis. CONCLUSION: The continuous duct to mucosal suture of the pancreaticojejunostomy is a very safe procedure, minimizing the operative morbidity and mortality of the Whipple operation.

Follow-Up Studies↗

Bacteremia following postoperative choledochofiberscopy--a prospective study.

BACKGROUND/AIMS: The following investigation was undertaken in order to determine the frequency and clinical consequences of bacteremia after postoperative choledochofiberscopy. MATERIALS AND METHODS: A total of 100 patients were prospectively studied for the frequencies of bacteremia after postoperative choledochoscopy. RESULTS: Positive blood cultures were obtained in 15%; at 5-minutes period in seven patients, at 15-minutes in eight patients and at 30-minutes in two patients. There were two patients with positive cultures at 5 minutes and 10 minutes periods. All the bacteria species cultured were aerobes. Enterococcus, E-coli and Klebsilla were the most commonly cultured bacteria. The frequencies of occurrence of bacteremia seemed not be influenced by the existence of residual stones, session of the endoscopy and duration of the procedure. Six of the 15 bacteremic patients developed cholangitis within 24 hours of the procedure. They all recovered with antibiotic treatment. Patients with negative blood cultures were not found with cholangitic symptoms after the postoperative choledochoscopy. CONCLUSIONS: The results of our study indicated that fifteen percent of patients undergoing postoperative choledochofiberscopy are associated with bacteremia. We believe that with adequate aseptic preparation and meticulous, gentle manipulation, routine prophylactic antibiotics may not be necessary for postoperative choledochoscopy in selected conditions.

Bacteremia↗

Factors influencing survival after hepatectomy for peripheral cholangiocarcinoma.

BACKGROUND/AIMS: Radical resection for patients with peripheral cholangiocarcinoma is rare. Prognostic factors related to survival with peripheral cholangiocarcinoma after hepatectomy have not yet been reported. MATERIALS AND METHODS: Of 41 hepatectomized patients with peripheral cholangiocarcinoma, a computer analysis of 14 clinicopathological factors on patients survival was performed with univariate and multivariate analysis. RESULTS: Median and mean survival times for patients with peripheral cholangiocarcinoma after hepatectomy were 12.0 and 22.8 months. The 1-, 2-, 3-, 4- and 5-year survival rates were 53.7%, 39.0%, 36.6%, 26.8%, and 26.8% respectively. Univariate analysis of overall survival involving all patients identified 7 factors that were associated with a significantly outcome: mucobilia (p = 0.043), capsular invasion (p = 0.007), tumor spreading type (p = 0.0003), section margin (p = 0.001), histologic type (p = 0.008), macroscopic and microscopic vascular involvement (p = 0.031), and lymphatic invasion (p = 0.004). With multivariate analysis using the COX stepwise proportional hazards model, only mucobilia, tumor spreading type and section margin were significantly related to prognosis. CONCLUSIONS: Intrahepatic bile duct carcinoma patients with mucobilia, intraductal papillomatosis and a tumor-free margin after hepatectomy had a better prognosis.

Bile Duct Neoplasms↗

Surgical treatment of pancreatic adenocarcinoma: Taiwan experience.

A retrospective study of 155 patients with tissue proven ductal adenocarcinoma of the pancreas treated between January 1981 and December 1991 was performed. Locations of the pancreatic tumors were: pancreatic head in 109 cases (70.3%), head and body or diffusely throughout the gland in 24 patients (15.5%), body and/or tail in another 22 (14.2%). All of the patients were stratified by TNM staging (I, 13.6%; II, 8.4%; III, 34.8%; IV, 43.2%). Twenty-eight patients received pancreatectomies (18.1%), 87 patients had biliary-enteric bypass and/or gastrojejunostomies (56.1%), and another 40 received laparotomies with tumor biopsy only (25.8%). The overall operative mortality of pancreatic cancer surgery was 9.0% with the pancreatectomy, bypass, laparotomy group mortalities at 7.1%, 5.7%, and 17.5% respectively. The risk factors of postoperative mortality were age > or = 70 years, serum albumin 3.0 g% and hemoglobulin < 12.0 g% (p < 0.05). The overall long term survival for pancreatic cancer was: 1y, 17.1%; 2y, 8.5%; 3y, 7.6%; 4y, 5.7%; and 5y, 4.8%; respectively. The mean survival time for the resection group was 23.6M (range 1-108M) with survival rates being: 1y, 42.3%; 2y, 34.6%; 3y, 30.8%; 4y, 23.1%; and 5y, 19.2%; respectively. Stage I cancer and radical resection are two important factors related to long-term survival in patients with pancreatic adenocarcinoma.

Adenocarcinoma↗