Biomedical subjects

Po-Huang Lee

Publications and source records attributed to Po-Huang Lee.

At least 73 records · Page 4Linked to original sources

PubMed2003

Treatment of centrally located hepatocellular carcinoma with central hepatectomy.

BACKGROUND: For treatment of centrally located hepatocellular carcinoma (HCC), central hepatectomy (including central trisegmentectomy [Couinaud's segments 4, 5, and 8] and anterior segmentectomy [Couinaud's segments 5 and 8]) may have an important advantage (ie, preservation of nontumorous parenchyma) over conventional lobectomy or extended lobectomy. For determination of the efficacy of this technique, we compared the outcomes of patients with HCC who underwent treatment with the central and conventional methods. PATIENTS AND METHODS: In our institute, 52 patients with HCC underwent treatment with central hepatectomy (group 1) and 63 patients with comparable tumor size underwent treatment with conventional major hepatectomy (group 2) from November 1993 to April 1999. Overall patient survival and disease-free survival rates were calculated and analyzed. The possible prognostic risk factors for patient and disease-free survival in group 1 were analyzed. RESULTS: Group 1 had comparable overall patient and disease-free survival rates with those of group 2. Vascular invasion, higher pathology grading, and resection margin less than 1 cm appeared to be the prognostic factors for overall patient survival, and vascular invasion was the only risk factor for disease-free survival. CONCLUSION: Central hepatectomy is a safe and effective operative procedure for the treatment of centrally located HCC. The patient and disease-free survival rates were the same as those of conventional major hepatectomy. Although it is technically more demanding, central hepatectomy preserves more nontumor liver parenchyma, which is important for the survival of those patients with liver cirrhosis.

Adult↗

PubMed2003

Pentoxifylline modulates intracellular signalling of TGF-beta in cultured human peritoneal mesothelial cells: implications for prevention of encapsulating peritoneal sclerosis.

BACKGROUND: Peritoneal matrix accumulation is a major characteristic of encapsulating peritoneal sclerosis (EPS), which is a serious complication in long-term peritoneal dialysis (PD) patients. We reported previously that TGF-beta stimulates collagen gene expression in cultured HPMC, and is attenuated by pentoxifylline (PTX). The SMAD family and the mitogen-activated protein kinase (MAPK) (ERK1/2, JNK and p38(HOG)) pathways have been shown to participate in TGF-beta signalling. However, how PTX modulates the intracellular signalling downstream to TGF-beta remains undetermined in HPMC. In this study, we explored these signalling pathways in HPMC, and investigated the molecular mechanisms involved in the inhibitory effects of PTX on TGF-beta-induced collagen gene expression in HPMC. METHODS: HPMC was cultured from human omentum by an enzyme digestion method. The expression of collagen alpha1(I) mRNA was determined by northern blotting, while the SMAD proteins and the MAPK kinase activity were determined by western blotting. RESULTS: TGF-beta-stimulated collagen alpha1(I) mRNA expression of HPMC was inhibited by PTX. The Smad2, ERK1/2 and p38(HOG) pathways were activated in response to TGF-beta. However, TGF-beta displayed no activation of the JNK pathway in HPMC. The addition of PD98059 and SB203580, which blocked the activation of ERK1/2 and p38(HOG), respectively, suppressed the TGF-beta-induced collagen alpha1(I) mRNA expression. At a concentration (300 micro g/ml) that inhibited the collagen gene expression, PTX suppressed the ERK1/2 and p38(HOG) activation by TGF-beta. In contrast, PTX had no effect on the TGF-beta-induced activation of Smad2, under the same concentration. CONCLUSION: PTX inhibits the TGF-beta-induced collagen gene expression in HPMC through modulating the ERK1/2 and p38(HOG) pathways. Our study of PTX may provide the therapeutic basis for clinical applications in the prevention of EPS.

Blotting, Northern↗

PubMed2003

Clinicopathologic characteristics and prognoses of gastric cancer in patients with a positive familial history of cancer.

BACKGROUND: There is a significant association between a positive family history of cancer and gastric cancer risk; however, the clinicopathologic characteristics and prognoses of gastric cancer patients with a positive family history of cancer are not clear. GOALS: To define the clinicopathologic characteristics and prognoses of gastric cancer patients with a positive family history of cancer. STUDY: We reviewed 548 patients with pathologically confirmed primary gastric cancer who had undergone a gastrectomy between 1990 and 1996. The average age was 59.7 years, and the male-to-female ratio was 1.7. The familial cancer histories of these patients were reviewed, and the various clinicopathologic characteristics of those patients with a positive family history of cancer were compared with those with a negative history. RESULTS: Among this cohort, 74 (13.5%) patients had a positive family history of cancer in their primary or secondary relatives. The most common cancer was gastric cancer in 29 patients, followed by colorectal cancer in 10 and lung cancer in 7. Patients with a positive family history of cancer were associated with bigger tumors, and more patients received a total gastrectomy than did patients with a negative family history. Immunopathologic study disclosed a higher rate of p53 overexpression but not of neu or c-met in patients with a positive family history of cancer. There were no differences in the mean age, gender, site, depth of invasion, or TNM stage. The survival curve of patients with a positive family history of malignancy was similar to that of patients without a family cancer history. CONCLUSION: Patients with gastric cancer with a positive family history of cancer appeared to have bigger tumors with a higher rate of p53 overexpression, and more patients required a total gastrectomy compared with those with a negative family history. This study suggests a genetic component in the aggressiveness of gastric cancer and indicates that higher caution should be exercised with people who have a positive family history of cancer.

Aged↗

PubMed2003

Low-dose thalidomide treatment for advanced hepatocellular carcinoma.

OBJECTIVE: To analyze the efficacy of oral thalidomide in the treatment of advanced hepatocellular carcinoma (HCC). METHODS: Sixty-eight patients with unresectable and nonembolizable HCC were consecutively enrolled in a compassionate treatment program of oral thalidomide. Tumor response and treatment-related toxicity were prospectively followed. Thalidomide was given at a starting dose of 200 mg per day. The dose was gradually escalated in 100-mg steps up to 600 mg per day if no limiting toxicities developed. RESULTS: Sixty-three patients were evaluable for response. One complete and 3 partial responses, defined by World Health Organization criteria, were seen, with a response rate of 6.3% (95% CI 0-12.5). The duration of response was 50+, 24.6, 11.6+ and 8.7+ weeks, respectively. All 4 responders had a dramatic decrease in alpha-fetoprotein (alpha-FP) levels. Another 6 of the 42 patients with elevated alpha-FP levels before treatment had a more than 50% decrease in their alpha-FP levels after thalidomide treatment. Totally 10 patients had an objective response to thalidomide. The median overall survival for all of the 68 patients was 18.7 weeks (95% CI 11.8- 25.6) with a 1-year survival rate of 27.6%. The median overall survival of the 10 patients with an objective response to thalidomide was 62.4 weeks (95% CI 31.2-93.6 weeks). All responders responded at a dose equal to or less than 300 mg per day. Toxicities of thalidomide were generally manageable, and only 16, 6, and 0 patients developed grade 2, 3, and 4 toxicities, respectively. CONCLUSION: Low-dose thalidomide is safe and induces unequivocal tumor response in a minority of patients with advanced HCC.

Administration, Oral↗

PubMed2003

Effect of sirolimus in combination with low-dose cyclosporine and steroids on acute renal allograft rejection.

BACKGROUND AND PURPOSE: Sirolimus is a novel immunosuppressive drug with much less nephrotoxicity than cyclosporine. The efficacy and toxicity of the combination of sirolimus and low-dose cyclosporine therapy were compared with data from records of a previous cyclosporine-based regimen used in patients with renal allograft transplantation. PATIENTS AND METHODS: A prospective study was conducted to assess the clinical effects of a sirolimus (6 mg loading dose over 48 hours plus 2 mg/day maintenance)/cyclosporine (8 mg/kg/day) combination regimen. Three male and 9 female renal transplant recipients were enrolled in the study. The primary endpoint was the incidence of acute rejection. The efficacy and adverse effects of the combined therapy were compared with those recorded in medical records of 24 renal transplant recipients who had received a cyclosporine-based regimen (10 mg/kg/day). RESULTS: The 12-month acute rejection rate of the study group was 16.67% (2/12), and that of the cyclosporine-based group 29.16% (7/24). One patient in the study group died of complications sustained during a radical operation for recurrent bladder carcinoma during the sixth post-transplant month. The 12-month graft and patient survival rates of the study group were both 91.8%. In the 12 months post-transplant, the mean serum creatinine levels of the study group were significantly lower than those of the historic group at months 1, 3, and 4. The average cyclosporine trough levels of the study group were significantly lower than those of the historic group at months 1, 2, and 12. The average daily doses of prednisolone in the study group were also lower than those of the historic group at months 2, 3, 4, and 12. CONCLUSIONS: The sirolimus/cyclosporine combination regimen reduced the incidence of acute renal allograft rejection, did not affect renal function, and reduced the dosage of cyclosporine and steroids compared with the cyclosporine regimen.

Acute Disease↗

PubMed2003

Successful living-related renal transplantation in a 2-year-old girl weighing less than 10 kilograms.

The success of renal transplantation for infants weighing less than 10 kg is very limited because of graft thrombosis. We report a successful living-related renal transplant in a 2-year-old girl weighing 9.5 kg. Chronic renal failure was diagnosed 1 month before the transplantation. Laparoscopic donor nephrectomy was performed to retrieve the left kidney of her father, a 36-year-old man weighing 70 kg, and the recipient operation was conducted via a right retroperitoneal approach. The right native kidney of the recipient was removed to accommodate the graft kidney during the transplant surgery. The graft renal artery, renal vein, and ureter were anastomosed to the recipient abdominal aorta, inferior vena cava, and bladder, respectively. The abdominal fascial defect was closed with absorbable mesh grafting, and the skin was closed primarily. With intensive fluid therapy and monitoring after reperfusion of the graft kidney, the patient recovered uneventfully and was discharged with an FK506-based immunosuppressive regimen 2 weeks after the operation. Renal function was good, and serum creatinine was 0.5 mg/dL 6 months after the operation.

Body Weight↗

PubMed2003

Sirolimus add-on rescue therapy can benefit patients with chronic renal allograft dysfunction.

BACKGROUND AND PURPOSE: Nephrotoxicity caused by calcineurin inhibitors (CNIs) contributes to chronic renal allograft dysfunction (CRAD). This retrospective cohort study evaluated the immunosuppressive and nephrotoxic effects of sirolimus add-on therapy with minimization of CNI in patients with CRAD. METHODS: Twenty patients with CRAD were recruited to receive sirolimus add-on rescue (SRL-AR) therapy. The SRL-AR therapy added 6 mg of sirolimus for loading and 2 mg/day for maintenance to CNI-based maintenance immunosuppressive regimens and reduced the dose of CNI, either cyclosporine or tacrolimus, by half at the initiation of sirolimus loading. The primary endpoint of the study was estimated glomerular filtration rate (GFR) determined using the Cockcroft-Gault formula. The efficacy of this SRL-AR therapy was evaluated by comparison to a historic group of 30 patients with CRAD who received a tacrolimus-based rescue therapy. RESULTS: Of the 20 patients receiving sirolimus therapy, 2 had graft failure during the 12-month follow-up. The post-rescue GFR values of the patients receiving sirolimus therapy showed greater improvement than those of the historic group during follow-up except for month 8, with the differences in GFR changes reaching significance at months 1 to 5 (p < 0.05). Multiple regression analysis identified graft age and GFR upon rescue in addition to the SRL-AR therapy as significant factors associated with post-rescue GFR changes. CONCLUSIONS: This study demonstrated that SRL-AR therapy combined with reduced CNI doses could effectively improve short-term renal function of patients with CRAD. The long-term outcome of rescuing CRAD is likely to depend on factors including graft age and GFR upon rescue.

Adolescent↗

PubMed2002

All chronic rejection failures of kidney transplants were preceded by the development of HLA antibodies.

BACKGROUND: Recent studies show that almost all patients who have rejected a kidney transplant had human leukocyte antigen (HLA) antibodies. In this study, we sought to determine whether patients develop HLA antibodies before chronic rejection. METHODS: For the past 8 years, 139 patients who had undergone kidney transplantation were systematically examined, using an enzyme-linked immunosorbent assay-based method, for the development of class-I and class-II HLA antibodies 3 months, 6 months, and yearly after transplantation. Chronic rejection was diagnosed by biopsy. RESULTS: Among 29 patients with chronic rejection, 100% of the patients had HLA antibodies before rejection. Of these patients, 14 patients developed antibodies de novo. In contrast, among 110 patients with stable function, 27% of the patients developed HLA antibodies posttransplant (P<0.001). CONCLUSIONS: HLA antibodies were found in 29 consecutive cases of chronic rejection failures as much as one year before the loss of grafts. We conclude that HLA antibodies may be a prerequisite for chronic immunologic rejection.

Autoantibodies↗

PubMed2002

High-frequency microsatellite instability predicts better chemosensitivity to high-dose 5-fluorouracil plus leucovorin chemotherapy for stage IV sporadic colorectal cancer after palliative bowel resection.

The influence of MSI on treatment outcome of colorectal cancers remains unclear and deserves further investigation. We recruited 244 patients with stage IV sporadic colorectal cancers for our study, based on appropriate eligibility criteria. Patients were nonrandomly allocated to 2 treatment groups of either with or without high-dose 5-FU plus leucovorin chemotherapy (HDFL, 5-FU 2,600 mg/m(2) leucovorin 300 mg/m(2) maximum 500 mg). Each treatment group was further divided into 2 subgroups according to high-frequency MSI (MSI-H) status. MSI-H was defined as the appearance of MSI in at least 2 of the 5 examined chromosomal loci (BAT-25, BAT-26, D5S346, D2S123, D17S250). We compared clinicopathologic parameters, p53 overexpression and overall survival between the groups. In addition, 4 subgroups were identified as follows: MSI-H(+)HDFL(+), n = 35; MSI-H(-)HDFL(+), n = 134; MSI-H(+)HDFL(-), n = 17; MSI-H(-)HDFL(-), n = 58. There was no significant difference of background clinicopathologic data between the HDFL(+) and HDFL(-) treatment groups (p > 0.05). Survival analyses indicated that the patients of subgroup MSI-H(+)HDFL(+) survived significantly longer than those of subgroup MSI-H(-)HDFL(+), with median survival times of 24 (95% CI 20.2-27.9) and 13 (95% CI 11.6-14.4) months, respectively (p = 0.0001, log-rank test). In contrast, in patients without chemotherapy, the prognosis was poor irrespective of MSI status, with median survival times of 7.0 (95% CI 4.6-9.4) and 7.0 (95% CI 6.1-7.9) months in the MSI-H(+)HDFL(-) and MSI-H(-)HDFL(-) subgroups, respectively (p = 0.8205, log-rank test). MSI-H cancers responded significantly better to HDFL (p = 0.001), with a mean response rate of 65.71% (95% CI 49.98-81.44%) in subgroup MSI-H(+)HDFL(+) compared to 35.07% (95% CI 26.99-43.15%) in subgroup MSI-H(-)HDFL(+). There appeared to be no preferential metastatic site where response to HDFL can be predicted based on the MSI status of the primary tumor. Toxicity to HDFL was similarly minimal between MSI-H(+) and MSI-H(-) patients (p > 0.05). Multivariate analysis of all patients further indicated that MSI-H and chemotherapy were independent favorable prognostic parameters (p < 0.05). Thus, the better prognosis of stage IV sporadic colorectal cancers with MSI-H may be associated with better chemosensitivity, rather than lower aggressiveness in biologic behavior.

Adult↗

PubMed2002

Handport-assisted laparoscopic living-donor nephrectomy; initial experience in Taiwan.

The feasibility of handport-assisted laparoscopic living-donor nephrectomy in Taiwan was assessed by comparison with conventional open nephrectomy. Six serial patients undergoing laparoscopic living-donor nephrectomy (LLDN) were compared with six patients undergoing open donor nephrectomy. Body-mass index (BMI), operating time, hospital stay, and short-term graft function were assessed in both groups of patients. Handport-assisted LLDN was successfully attempted in all six patients. Mean ischemic time was 4.5 min in the laparoscopic group. There was no major complication in either group. Short-term graft function was good in all patients, except for one case of chronic rejection with mild azotemia in the open group. The length of stay was significantly longer in the open group, but the operation time of the laparoscopic group was much longer than that of the open group. There was no difference in the resumption of diet and in the use of narcotic analgesics in addition to patient-controlled analgesia. LLDN is a technically demanding approach. With handport assistance, the surgeons could shorten their learning curve. While initial graft function rates are equal to those of the open method, cosmesis and hospital stay are improved by the laparoscopic approach. Longer follow-up and larger patient numbers are needed to confirm these initial results in Taiwan.

Adult↗

PubMed2002

Dominance of functional androgen receptor allele with longer CAG repeat in hepatitis B virus-related female hepatocarcinogenesis.

The CAG polymorphism in exon 1 of the androgen receptor (AR) gene has been shown associated with the development of human male hepatocellular carcinoma (HCC) with the shorter AR alleles conferring a higher risk. However, the significance of AR-CAG repeats in female hepatocarcinogenesis remains to be addressed. In this study, seventy-six pairs of female HCCs and corresponding nontumorous tissues were collected, and 180 cirrhotic nodules were microdissected from 7 cirrhotic livers. The clonality status, functional AR alleles, and CAG repeat number of each sample were determined by AR methylation analysis. In a total of 44 monoclonal HCCs, the mean of CAG repeats in the active alleles was significantly longer than that in the inactive alleles (22.0 +/- 2.8 versus 20.7 +/- 3.6; P = 0.047). When we divided HCCs into hepatitis B virus-positive [HBV(+)] and HBV(-) subgroups, the long AR allele dominance was found only in HBV(+) ones (P = 0.006 versus P = 0.923). Notably, the preference of long CAG repeat has also been found in the 100 monoclonal nodules (P = 0.013). For comparison of monoclonal nodules obtained from the same individual, a dominant long AR allele was found in 6 patients. The proportion of monoclonal cirrhotic nodules and HCCs expressing longer AR allele, 69 and 68%, are both significantly higher than 50%, the assumed value in normal liver (P < 0.001 for cirrhotic nodules and P = 0.005 for HCC). The dominance is again only prominent in HBV-infected HCCs [85% for HBV(+) HCC; P < 0.001 but 54% for HBV(-) HCC; P = 0.27]. The results indicated that in female hepatocarcinogenesis, hepatocytes expressing the longer AR allele seem to be favorably selected for autonomous growth and transformation, especially in synergy with HBV infection.

Adult↗

PubMed2002

Polycyclic aromatic hydrocarbon-DNA adducts in liver tissues of hepatocellular carcinoma patients and controls.

HCC is a common cancer and HBV and AFB(1) are well-documented, major risk factors. Epidemiologic studies have documented that cigarette smoking also contributes to the development of HCC. PAHs are ubiquitous environmental pollutants and products of incomplete combustion. They are present in both mainstream and sidestream cigarette smoke. PAHs are metabolically activated by phase I enzymes, including CYP1A1, into electrophilic reactants (diol epoxides), which covalently bind to DNA to form adducts. Diol epoxides are also substrates for phase II detoxifying enzymes, including GSTM and GSTP. To examine the association between PAH-DNA adducts and HCC, adduct levels were determined in liver tissue by relative staining intensity with an immunoperoxidase method using a polyclonal antiserum against BPDE-modified DNA. Subjects were also genotyped for polymorphism in several genes involved in the metabolism of PAH, including GSTM1 and GSTP1. Liver tissue was collected from patients with histologically confirmed HCC (n = 105) and from non-HCC controls (n = 37). There was a significant positive correlation (r = 0.3, p < 0.01) between adducts in tumor and adjacent nontumor tissues among HCC cases. The risk of HCC was higher after adjustment for age, sex and HBsAg in the group with the highest tertile tissue levels of PAH-DNA adducts (mean relative nuclear staining intensity of tumor and nontumor tissue > 344) than in the group with the lowest tertile (staining < 241, OR = 3.9, 95% CI = 1.0-14.9). Among non-HCC controls, there were no significant associations between adduct levels and cigarette smoking, GSTM1 null genotype and HBsAg positivity. A strikingly increased HCC risk was observed (OR = 20.3, 95% CI = 5.0-81.8) among HBsAg-positive subjects whose PAH-DNA adduct levels were high (mean relative nuclear staining intensity of tumor and nontumor tissue > 301, median of control tissues) compared to HBsAg-negative subjects who had low PAH-DNA adduct levels. 4-ABP- and AFB(1)-DNA adducts had been measured previously in these same tissues. Subjects with elevated DNA adduct levels of PAH, 4-ABP and AFB(1) had a significantly higher HCC risk with an OR of 36.7 (95% CI 7.2-187.2) compared to those who had low DNA adduct levels. These results suggest that PAHs may play a role in human hepatocarcinogenesis in conjunction with HBsAg carrier status, GSTM1 and GSTP1 genotypes and exposure to 4-ABP and AFB(1).

Aged↗

PubMed2002

HER-2/neu overexpression is rare in hepatocellular carcinoma and not predictive of anti-HER-2/neu regulation of cell growth and chemosensitivity.

BACKGROUND: The overexpression of HER-2/neu oncogene has been implicated in the development and modulation of many types of cancer. However, whether HER-2/neu overexpression plays a similar role in hepatocellular carcinoma (HCC) has not been determined. METHODS: Tissue specimens from 36 HCC patients who had been enrolled in 3 separate prospective clinical trials of systemic chemotherapy were studied by immunohistochemical staining. A polyclonal antibody (A0485; DAKO, Copenhagen, Denmark) against HER-2/neu and a horseradish peroxidase-based visualization system (Envision+, DAKO) was used. Scoring criteria was in accordance with the manufacturer's guidelines. Twelve HCC cell lines were examined for HER-2/neu overexpression by Western blotting. Single-agent growth regulatory activity of the anti-HER-2/neu antibody, trastuzumab (Herceptin; Genentech, South San Francisco, CA), and its combinative cytotoxicity with chemotherapeutic agents (doxorubicin, gemcitabine, cisplatin, irinotecan) were determined by a tetrazolium-based colorimetric assay (MTT test). RESULTS: All but one of the HCC tumor tissues were negative for HER-2/neu expression. The only patient with positive HER-2/neu expression was a 57-year-old male patient who achieved stabilization of disease for 2 months after chemotherapy. Eight of the 35 patients with negative HER-2/neu expression had had partial remission after chemotherapy (P = 0.78). Only one (Tong cells) of the 12 HCC cell lines had a significant level of HER-2/neu expression. However, trastuzumab up to 10 microg/mL had no discernible growth inhibitory or chemosensitizing effect on Tong cells or any other cell lines. CONCLUSIONS: HER-2/neu overexpression is rare in human HCC tissues, and anti-HER-2/neu regulation appears to play little role in the treatment of this tumor.

Antibodies, Monoclonal↗

PubMed2002

High frequency of promoter hypermethylation of RASSF1A and p16 and its relationship to aflatoxin B1-DNA adduct levels in human hepatocellular carcinoma.

Epigenetic changes in gene expression due to extensive CpG island methylation is now accepted as the main cause of inactivation of the p16 gene. More recently, it has been suggested that the human ras association domain family (RASSF) 1 gene, cloned from the lung tumor-suppressor locus 3p21.3, also may be inactivated by methylation. It consists of two major alternative transcripts, RASSF1A and RASSF1C. Epigenetic inactivation of isoform A was observed in several carcinomas and tumor cell lines. In this study, promoter hypermethylation of RASSF1A and p16 was investigated in 83 hepatocellular carcinoma (HCC) tissue samples from Taiwan and in two HCC cell lines (Hep3B and HepG2). High frequencies (85% and 47%, respectively) of methylation of the CpG island promoters of RASSF1A and p16 were found in the HCC tissues. The methylation of RASSF1A also was detected in Hep3B cells but not in HepG2 cells; p16 was not methylated in either cell line. Methylation status was determined in 12 normal control liver tissues and 10 adjacent nontumor tissues. No methylation was found in normal liver control tissues for both RASSF1A and p16; methylation was detected in one of 10 and seven of 10 adjacent nontumor tissue sampless for p16 and RASSF1A, respectively, in subjects with positive tumors. These data indicate that aberrant methylation of the CpG island promoters of both genes is a frequent occurrence in hepatocarcinogenesis. The high frequency of RASSF1A methylation in adjacent tissues suggests that this may be an early event. The relationship between methylation status and clinical parameters and tumor markers, including DNA damage resulting from aflatoxin B(1) (AFB(1)), an environmental carcinogen, and p53 status, also was analyzed. A statistically significant association was found between RASSF1A methylation status and the level of AFB(1)-DNA adducts in tumor tissues. No association was found between methylation status and p53 status. These results suggest the hypothesis that exposure to environmental carcinogens may be involved in altered methylation of genes involved in cancer development.

Aflatoxin B1↗

PubMed2002

Simultaneous detection of colonic epithelial cells in portal venous and peripheral blood during colorectal cancer surgery.

PURPOSE: This study was designed to show, in certain patients, that colonic epithelial cells can be present in peripheral blood while absent in portal venous blood. METHODS: The circulating colorectal epithelial cells were detected by a reverse transcriptase-polymerase chain reaction assay, which involved amplifying guanylyl cyclase C transcripts. Portal venous and peripheral blood samples were obtained at intervals from 58 patients undergoing colorectal cancer surgery. RESULTS: Circulating colonic epithelial cells were more frequently detected in portal venous blood than in peripheral blood only before mobilization of the tumor-bearing colon segment in patients with tumors of Stage B. In five other patients, before mobilization of their tumor-bearing colon segments, and in another three patients, during the mobilization, colorectal epithelial cells were detected in peripheral blood but not in portal venous blood. These eight patients had Stage C or D tumors. CONCLUSION: In 8 of 58 patients, colorectal epithelial cells were detected in peripheral but not in portal venous blood. Metastatic deposits in lymphatic vessels or liver might be the source of these cells.

Adult↗

PubMed2002

Elastic modulus measurements of human liver and correlation with pathology.

Viral hepatitis causes fibrosis in the liver and may change mechanical properties of the liver. To evaluate the impact of fibrosis on elastic properties of human liver and to investigate potential benefits of ultrasonic elasticity imaging, 19 fresh human liver samples and 1 hepatic tumor (focal nodular hyperplasia) sample obtained during operations were studied. Simple 1-D estimates based on the cyclic compression-relaxation method were performed. Elastic modulus values were derived from the predetermined strain (controlled by a step motor system) and the stress values (measured by an electronic balance). Each specimen subsequently received histologic examination and a grade of liver fibrosis was scored from 0 to 5. Results show that the elastic modulus values were on the order of several hundreds to thousands of Pascals. The elastic modulus generally increased with the fibrosis grade, although some discrepancies existed at the middle grades of fibrosis (scores 1 to 3). The correlation between the fibrosis score and the elastic modulus was significant (p < 0.01) based on the statistical analysis using the Pearson correlation method. In addition, the relation between the elastic modulus and the fibrosis grade generally exhibited a quadratic trend. It was concluded that severity of fibrosis had a good correlation with stiffness of the liver. Results also indicated that the elasticity imaging of the liver may provide significant clinical values if the elastic modulus can be accurately measured.

Elasticity↗

PubMed2002

Association of color Doppler vascularity index and microvessel density with survival in patients with gastric cancer.

OBJECTIVE: The purpose of this study was to investigate the clinical usefulness of microvessel density (MVD) and an in vivo angiogenesis parameter, color Doppler vascularity index (CDVI), in patients with gastric cancer. SUMMARY BACKGROUND DATA: Many studies have reported a significant association between the degree of MVD-evaluated angiogenesis with the clinicopathologic factors and prognosis of patients with various solid tumors. All these studies were accomplished on tissue sections retrospectively obtained from surgical specimens. However, an in vivo method to assess tumor angiogenesis for human malignancies is highly desirable for diagnostic purpose, treatment planning, and follow-up. The CDVI is a new ultrasound parameter for evaluating in vivo angiogenesis, has a good correlation with status of lymph node metastasis in cervical carcinoma, and can predict distant metastasis and survival in colon cancer patients. Therefore, the CDVI may also be useful to assess in vivo angiogenesis in human gastric cancer. METHODS: A total of 79 patients with gastric cancer were enrolled in this study, and microvessel density was evaluated by using immunohistochemical staining of surgical specimens with anti-CD-34 antibody. Tumors were sonographically visible in 31 patients. The CDVI of each tumor was determined using transabdominal color Doppler ultrasound. The CDVI was defined as the ratio of the number of the colored pixels within a tumor section to the number of total pixels in that specific tumor section, and was calculated by using Encomate software (Electronic Business Machine Co. Ltd., Taipei, Taiwan). Correlation between MVD, CDVI and clinicopathologic factors and patient survival was studied. RESULTS: The MVD was significantly correlated with vascular invasion by multiple linear regression analysis. Although the survival of patients with high MVD (> 32) was significantly worse than those with low MVD (< 32) by univariate analysis, vascular invasion was an independent prognostic factor by Cox proportional hazard model. There was a linear correlation between CDVI and MVD (r =.495, P =.005). Moreover, in patients with a high CDVI (> 11%), the survival rate was significantly lower than that in those with low CDVI (< or = 11%, P =.005). None of the patients with high CDVI (> 11%) survived 2 years after curative resection. In addition to vascular invasion, the CDVI was another independent prognostic factor in the patients with stage III gastric cancer. CONCLUSIONS: Vascular invasion was an important prognostic indicator in gastric cancer. The high CDVI was a good preoperative indicator of early death in stage III gastric cancer patients. Thus, the CDVI may be helpful in selecting patients with gastric cancer for neoadjuvant chemotherapy and/or anti-angiogenic therapy.

Adenocarcinoma↗

PubMed2002

Technical considerations in hand-assisted laparoscopic live donor nephrectomy: initial Taiwan experience from National Taiwan University Hospital.

This report describes the initial experience of laparoscopic live donor nephrectomy (lap-LDN) in Taiwan and discusses the technical considerations and modifications of our technique. From September to November 2000, three (one right and two left) lap-LDNs were performed at our institute. The right kidney was retrieved in one donor because of an early branching of the left renal artery. The details of our technique are described for both left and right LDN. The perioperative parameters were compared to those of the 10 immediately preceding cases of LDNs using the traditional open approach. All lap-LDNs and open LDNs were successful, and all 13 recipients had smooth recovery of renal function. The donors recuperated better in the lap-LDN group with resumption of oral intake on postoperative day (POD) 1 and discharge on POD 5 (vs POD 3.4 and 8.5, respectively, in the open group). The mean blood loss was lower and narcotic use was less in the lap-LDN group (75 vs 164 mL, 25 vs 47 mg morphine sulfate equivalent, respectively). The extraction wound was much shorter in the lap-LDN group (6.5-8 vs 23 cm). The warm ischemia time was slightly but not significantly shorter in the open group (4 vs 2.75 min), and the average operative time was shorter in the open group. The results of our initial experience suggest that for surgeons with laparoscopic surgery experience, lap-LDN is a feasible procedure that decreases donor discomfort, while improving the quality of graft kidneys and the safety of the donor.

Humans↗