Biomedical subjects

S M Sheen-Chen

Publications and source records attributed to S M Sheen-Chen.

At least 19 recordsLinked to original sources

PubMed2001

Serum levels of matrix metalloproteinase 2 in patients with breast cancer.

Matrix metalloproteinases (MMPs) have been reported to be associated with invasive and metastatic behaviors of human malignant tumors. However, there is still limited knowledge about the role of matrix metalloproteinases-2 (MMP-2) in breast cancer. This study was designed with the aim to elucidate the possible relationship between the preoperative circulating MMP-2 and breast cancer. Fifty-seven consecutive patients with invasive breast cancer undergoing surgery were prospectively included and evaluated. Venous blood samples were collected before the surgery. Sera were obtained by centrifugation, and stored at -70 degrees C until assayed. The control group consisted of 12 patients with benign breast tumor (six with fibrocystic disease and six with fibroadenoma). Serum concentrations of MMP-2 were measured by the quantitative sandwich enzyme immunoassay technique. The data on primary tumor stage, age, estrogen receptor, lymph node status, and TNM staging were reviewed and recorded. The mean value of serum MMP-2 in patients with invasive breast cancer was 694.3+/-140.5 ng/ml and those of control group were 593.3+/-134.0 ng/ml and the difference was significant (P=0.026). Furthermore, there were significantly higher serum levels of MMP-2 in the patients with more advanced primary tumor staging (P=0.005), in the patients with more advanced lymph node status(P=0.011) and in the patients with more advanced TNM staging (P<0.001). In multivariate analysis, TNM staging (P<0.001) appeared as independent factor regarding the significant higher serum levels of MMP-2. Patients with more advanced TNM staging were shown to have higher serum MMP-2 levels. Thus preoperative serum MMP-2 levels might reflect the severity of invasive breast cancer and deserve further evaluation.

Adult↗

PubMed2001

Serum levels of transforming growth factor beta1 in patients with breast cancer.

HYPOTHESIS: Transforming growth factor beta1 (TGF-beta1) may be related to breast cancer progression. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Sixty consecutive patients with invasive breast cancer undergoing surgery were prospectively included and evaluated. The control group consisted of 14 patients with benign breast tumors (7 with fibrocystic disease and 7 with fibroadenoma). INTERVENTION: Venous blood samples were collected before the surgery. Sera were obtained by centrifugation and stored at -70 degrees C until assayed. Serum concentrations of TGF-beta1 were measured by quantitative sandwich enzyme immunoassay. Data on primary tumor stage, age, estrogen receptor status, lymph node status, distant metastases, and TNM staging (according to the Union Internationale Contre le Cancer) were reviewed and recorded. MAIN OUTCOME MEASURES: Measurements of preoperative serum TGF-beta1 levels in patients with breast cancer. RESULTS: The mean +/- SD value of serum TGF-beta1 in patients with invasive breast cancer was 498.7 +/- 249.7 pg/mL and in the control group was 495.2 +/- 225.5 pg/mL (P =.96). However, there were significantly higher serum levels of TGF-beta1 in patients with more advanced lymph node status (P =.04), more advanced TNM stage (P =.005), and poorer histological grade (P =.02). In multivariate analysis, TNM staging (P =.02) was demonstrated to be the independent factor related to significantly higher serum levels of TGF-beta1. CONCLUSIONS: Patients with more advanced TNM stages were shown to have higher serum TGF-beta1 levels. Thus, serum TGF-beta1 levels may reflect the severity of invasive breast cancer.

Adult↗

PubMed2001

Parathyroidectomy can improve bone mineral density in patients with symptomatic secondary hyperparathyroidism.

HYPOTHESIS: The recovery of osteoporosis or bone mineral density (BMD) after parathyroidectomy and autotransplantation can be improved in patients with symptomatic secondary hyperparathyroidism. DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: Forty-five patients with symptomatic secondary hyperparathyroidism who underwent total parathyroidectomy and autotransplantation were included. They were divided into an osteoporotic group (n = 20) and a nonosteoporotic group (n = 25) according to preoperative T scores less than -2.5 at either the lumbar spine (L1-L4) or the femoral neck (FN). INTERVENTIONS: Serum levels of calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone were checked before surgery and 1 day, 1 week, and 3 months after surgery. The BMDs of the FN and L1-L4 were measured using dual-energy x-ray absorptiometry before surgery and 6 months after surgery. RESULTS: Patients with osteoporosis were older (mean +/- SD, 50.2 +/- 14.0 years) than those without osteoporosis (42.7 +/- 9.1 years) (P =.04). Except for bone fractures found in 2 women in the osteoporotic group, there were no significant differences between the 2 groups in sex, clinical manifestations, duration of dialysis, weight of removed parathyroid tissue, and types of dialysis. Also, serum levels of calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone were similar in both groups. Both 1 day and 1 week after total parathyroidectomy and autotransplantation, serum levels of calcium and intact parathyroid hormone decreased rapidly and then gradually increased 3 months later; however, serum levels of alkaline phosphatase increased rapidly and then gradually decreased 3 months later. Six months after parathyroidectomy, BMD, T score, and Z score at L1-L4 and the FN increased significantly (P<.001). The increment was much better in the osteoporotic group than in the nonosteoporotic group (P<.001). Also, osteopenia or osteoporosis improved significantly after parathyroidectomy at both L1-L4 and the FN (P<.001 for both). CONCLUSION: Parathyroidectomy and autotransplantation can improve BMD of symptomatic secondary hyperparathyroidism at L1-L4 and the FN.

Absorptiometry, Photon↗

PubMed2001

Paget disease of the breast--an easily overlooked disease?

BACKGROUND AND OBJECTIVES: Paget disease of the breast has long been recognized as a distinct clinical disease. The clinical manifestations and outcomes of Paget disease of the breast were reviewed to understand its earlier diagnostic clues and achieve an optimal treatment plan. Patients and Methods Thirty-one patients with Paget disease of the breast were included in this study. The postoperative outcomes and possible related prognostic factors were reviewed and analyzed. RESULTS: The 5-year overall survival was 69%. Nineteen patients (61%, Group A) did not have a palpable breast mass and 12 patients (39%, Group B) had a palpable breast mass. There was significant difference (P < 0.01) in the 5-year overall survival between Group A (94%) and Group B (19%). Group A patients had significantly higher incidences of underlying noninvasive breast carcinoma (73% vs. 8%, P < 0.01) and n0 lymph nodes status (84%vs. 50%, P = 0.043) than those of Group B. CONCLUSIONS: Paget disease of the breast without a palpable breast mass carries a more favorable prognosis. Patients with any nipple complaints deserve a detailed evaluation even in the absence of a palpable breast mass in order not to overlook a favorable disease.

Adult↗

PubMed2001

Computed tomography and angiography in hepatic tuberculosis mimicking liver tumor.

Tuberculosis is one of the most common and well-documented infectious diseases, with a vast variety of clinical manifestations. A case of isolated hepatic tuberculosis mimicking liver tumor is presented. The patient was a 44-year-old man who had suffered from intermittent epigastralgia for about 2 years. Abdominal computed tomography demonstrated a low density mass with internal calcification over the left lobe of the liver. Celiac angiography showed encasement of the hepatic propia and occlusion of the left hepatic artery. Abnormal tortuous vascular structures were found at the hepatic hilar region. The patient underwent surgical intervention under the impression of left liver tumor. Microscopically, the resected liver tissue specimen revealed tuberculosis.

Adult↗

PubMed2000

Synchronous and "early" metachronous colorectal adenocarcinoma: analysis of prognosis and current trends.

PURPOSE: We evaluated the accuracy of preoperative diagnostic examinations and determined whether patients with synchronous colorectal cancers differ from patients with a single colorectal malignancy in clinicopathologic factors, the possibility of early metachronous colorectal cancer, and postoperative outcome. METHODS: A retrospective evaluation of 1,780 patients with primary colorectal adenocarcinoma from 1987 to 1993 was performed. We divided patients into three groups: Group 1, single colorectal adenocarcinoma; Group 2, synchronous colorectal adenocarcinoma; and Group 3, early metachronous colorectal adenocarcinoma. RESULTS: There were 52 cases (3 percent) in Group 2 and 13 cases (1 percent) in Group 3 (<3 years from the index colorectal cancer operation). Differences in age, gender, and cancer-free rate among the three groups did not reached statistical significance. Compared with cancers in Group 1, significantly more proximal tumor locations and early cancer stage were noted for the second and third cancers in Group 2. In Group 3 a significantly more proximal tumor site was noted for the index colorectal cancer but cancer stage showed no significant difference from cancers in Group 1. Better histologic type was also noted in the index and second cancers in Group 2 than in cancers in Group 1. There was a higher incidence of associated benign adenoma in Group 2 (35 vs. 15 percent in Group 1). The positivity rate of Group 2 was significantly higher by preoperative colonoscopy (71 percent) and incidental findings at surgery (58 percent) than barium enema examination (30 percent). CONCLUSION: Preoperative barium enema examination was an unsatisfactory tool for detecting synchronous tumors. Preoperative colonoscopy demonstrated a higher positivity rate, but it still failed to detect nearly 30 percent of cases with synchronous tumors. Intraoperative palpation of the whole colorectum could detect nearly 60 percent of unexpected synchronous tumors. We believe both colonoscopy and intraoperative palpation of the whole colorectum are crucial to the early detection of synchronous colorectal cancer.

Adenocarcinoma↗

PubMed2000

Treatment of complicated hepatolithiasis with intrahepatic biliary stricture by ductal dilatation and stenting: long-term results.

A group of 190 cases of hepatolithiasis with postoperative residual stones located proximal to the stricture sites were managed with the aim of complete clearance of stones and relief of bile stasis to decrease the potential risk of recurrence. All procedures were performed through a T-tube track with gradual dilatation and stent placement through the stricture sites, creating a channel that allows cholangioscopy and electrohydraulic lithotripsy. Complete clearance of intrahepatic duct (IHD) stones was achieved in 88.4% of cases. Multiple sharply angulated IHD strictures in right-sided hepatolithiasis constituted a major cause of failure. Recurrent stone formation and repeated cholangitis, subsequent drainage, and liver resection are associated with high mortality rates particularly if there is late development of a cholangiocarcinoma. We concluded that postoperative ductal dilatation and stenting through the T-tube track combined with endoscopic electrohydraulic lithotripsy is effective and safe for managing complicated hepatolithiasis. Persistent irreversible aneurysmal dilatation of IHD and atrophic change of the affected hepatic lobe at follow-up were ominous signs of recurrence and cholangiocarcinoma development. Early drainage with stone extraction combined with surgical intervention can prevent subsequent morbidity and mortality.

Adult↗

PubMed2000

A study on pruritus after parathyroidectomy for secondary hyperparathyroidism.

BACKGROUND: The effective therapy for uremic pruritus remains a clinical challenge, and the factors affecting the pruritus before and after parathyroidectomy have not been defined. STUDY DESIGN: Thirty-seven patients were operated on for secondary hyperparathyroidism. Their ages ranged from 14 to 73 years, and the duration of dialysis from 12 to as long as 168 months. Indications for surgery were skin itch in 22 patients and other reasons in 15 patients. Serum levels of calcium, phosphorus, intact PTH (i-PTH), and alkaline phosphatase were checked at two different intervals-before surgery and 1 week after operation. Immunohistochemical stain of mast cells, antihuman macrophage (CD68), antihuman dendritic reticulum cell (CD35), and i-PTH (IHPTH) were performed on skin specimens. Skin samples were prepared into tissue homogenates and analyzed for concentrations of interleukin-2 (II-2) and tumor necrosis factor-alpha (TNF-alpha). II-2 and TNF-alpha were measured by sandwich enzyme-linked immunosorbent assay. The extent of pruritus was evaluated on a visual analog scale (VAS) ranging from 0 to 10 and a behavior rating scale (BRS) ranging from 0 to 5, at a preoperative stage and 1 week after operation. RESULTS: Serum levels of calcium, phosphorus, the product of calcium and phosphorous (Ca x P), alkaline phosphatase, and i-PTH changed significantly after parathyroidectomy. The VAS decreased from 5.4 +/- 3.2 to 1.8 +/- 1.5 (p < 0.001). Significant improvement of BRS was achieved 1 week after surgery (p < 0.001), and in the followup period. Before surgery, there was no correlation between serum levels of calcium, phosphorus, Ca x P, alkaline phosphatase, i-PTH, number of mast cells, CD68, CD35, and IHPTH, and the scale of itch estimated with either VAS or BRS. The tissue levels of Il-2 and TNF-alpha were not detectable in any of them. We noted that high levels of phosphorus and Ca x P affected the postoperative extent of pruritus. But a linear regression test showed Ca x P was the only factor affecting postoperative itch. CONCLUSIONS: Pruritus in patients with secondary hyperparathyroidism can be reduced by parathyroidectomy. Apparently, high-level Ca x P is the only factor that seems to affect the postoperative extent of pruritus.

Adult↗

PubMed2000

Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends.

BACKGROUND: In adenocarcinoma of the colon and rectum, obstruction and perforation may occur either alone or together at the site of the neoplasm or proximally. Both events carry a poor prognosis. This retrospective study sought to determine whether a correlation exists between perforation and obstruction, and between these conditions and different clinicopathological factors in colorectal adenocarcinoma. METHODS: The medical records of 1950 patients with colorectal adenocarcinoma treated in our hospital during a 7-year period were retrospectively analyzed. One hundred patients (5%) were excluded from this study because of a loss of follow-up. Data on clinicopathological factors including age, sex, tumor location, surgical mortality, pathological type, stage, and long-time cancer-free rate were simultaneously analyzed. Patients were grouped as follows: Group 1, complete colonic obstruction without perforation (n = 120). Group 2, complete obstruction with perforation at the site of the cancer (n = 35); Group 3, complete obstruction with perforation proximal to the cancer (n = 13); and Group 4, nonobstructing, nonperforated cancers (n = 1682). RESULTS: When compared with Group 4, Group 1 had a more advanced Dukes' stage, older age, greater incidence of colonic versus rectal cancers, and a poorer cancer-free survival (P < or = .005). Groups 2 and 3 had a greater incidence of colonic versus rectal cancers (P < or = .004), and Group 3 had a greater operative mortality (P < .001). No significant differences were found between Groups 1, 2, and 3. Multivariate analysis revealed that the independent factors favorable to cancer-free survival (> 5-year survival) were female gender (P = .035), well-differentiated pathology (P < .001), uncomplicated cases (P = .004), colon versus rectal location (P < .001), and early stage (P < .001). CONCLUSIONS: The perioperative mortality rate for perforated colorectal cancer at the site of the cancer was 9%; for obstructive colorectal cancer, 5%. Perioperative mortality was much greater for perforations of the colon and rectum occurring proximal to the cancer (31%). Survival was worse (P < .001) for patients with obstruction (33%) or perforation proximal to the cancer (33%). The site of perforation did not appear to impact the 5-year survival, although the numbers are relatively small.

Adenocarcinoma↗

PubMed2000

Pregnancy complicated by concurrent primary hyperparathyroidism and arrhythmia.

Primary hyperparathyroidism during pregnancy results in a high rate of fetal complications and maternal morbidity. Maternal hypercalcemia in pregnancy results in fetal hypercalcemia, which leads to suppression of fetal parathyroid function. Spontaneous abortion and stillbirth can occur, and the loss of maternal calcium after birth leads to neonatal hypocalcemia. It is essential to detect primary hyperparathyroidism during pregnancy because early diagnosis and management can decrease the rate of fetal and maternal complications. We present the case of a 27-year-old gravida 1, para 0 woman whose pregnancy was complicated by hyperparathyroidism and arrhythmia. The patient complained of dyspnea and palpitations in the seventh and 15th weeks of gestation. Electrocardiography showed ventricular premature contraction bigeminy and trigeminy in association with hypercalcemia (3.3 mmol/L). A parathyroidectomy in the second trimester revealed parathyroid adenoma. Hypercalcemia and arrhythmia resolved completely and the patient delivered a term baby without any maternal or fetal complications. The simultaneous occurrence of arrhythmia with ventricular premature contractions and hyperparathyroidism in pregnancy is rarely reported. Palpitations and dyspnea due to arrhythmia may be associated with primary hyperparathyroidism in pregnancy and should be considered in the differential diagnosis. In the management of symptomatic primary hyperparathyroidism during pregnancy, surgical intervention is preferable in the second trimester when organogenesis is completed and the risk of spontaneous abortion is low.

Adult↗

PubMed1999

Evaluation of the prognostic value of serum soluble CD 44 in patients with breast cancer.

The outcome of breast carcinoma is usually determined by multiple factors. Aberrant expression of the cell adhesion molecule CD 44 has been claimed to be associated with poor prognosis in various human malignancies. This study was designed to investigate any correlation between the soluble adhesion molecule CD 44 and the clinicopathologic variables and to evaluate the possible prognostic significance of soluble CD 44. Venous blood samples were preoperatively collected from 100 patients with invasive breast carcinoma. The serum levels of different soluble CD 44 molecules (CD 44 standard form and CD 44 splice variant V6) were measured with an enzyme immunoassay method. The data of primary tumor status, age, estrogen receptor status, lymph node status, histologic grading, distant metastases status, TNM staging, S-phase fraction, and ploidy pattern were collected and evaluated simultaneously with the serum levels of soluble CD 44 st and CD 44 V6. Twenty healthy subjects were used as the control group. The serum levels of soluble CD 44 st showed no significant elevation in patient group. The mean value of soluble CD 44 V6 in patient group was 269.2 +/- 94.3 ng/ml and that of the control group was 179.5 +/- 50.7 ng/ml; the difference was significant (p < 0.01). In multivariate analysis, distant metastasis (p < 0.05) and TNM staging (p < 0.01) appeared as independent factors regarding the significant higher serum levels of soluble CD 44 V6. Based on our preliminary results, preoperative serum soluble CD 44 V6 is closely related to distant metastases and TNM staging. The possible role of soluble CD 44 V6 in the prognostic value of breast carcinoma deserves further elucidation and evaluation with long-term patient follow-up.

Adult↗

PubMed1998

Obstructive jaundice alters Kupffer cell function independent of bacterial translocation.

BACKGROUND: There is a high incidence of perioperative morbidity and mortality in patients with obstructive jaundice. The absence of bile in the gastrointestinal tract promotes bacterial overgrowth and the increased translocation of bacteria and endotoxin to the liver which has been postulated to inhibit Kupffer cell function in these patients. But, biliary tract obstruction can directly damage liver cells and thus alter their function. Thus, we hypothesized that obstructive jaundice alone alters Kupffer cell function independent of the effects of bacterial translocation. This study was designed to evaluate the contribution of bacterial translocation to the altered Kupffer cell function observed in patients with obstructive jaundice. METHODS: Sprague-Dawley rats were randomized to three groups of six animals each. Group 1 underwent common bile duct ligation with intestinal bile salt replacement (sodium taurocholate 100 mg/kg/day) via gastrostomy and an implantable osmotic pump (CBDL + bile salts), Group 2 underwent common bile duct ligation with normal saline replacement (CBDL + saline), and Group 3 underwent a sham operation (sham control). After 7 days, tissue and blood were collected for bacterial translocation and biochemical analyses. Examination of cultured Kupffer cell function included measuring the phagocytosis of heat-killed Candida albicans and endotoxin (LPS)-induced TNFalpha and nitric oxide production. RESULTS: While bacterial translocation and cecal bacterial counts were significantly increased in the CBDL + saline group, these parameters were both reduced to control levels following intestinal bile salt replacement (CBDL + bile salts). Altered Kupffer cell function, as measured by the increased phagocytosis of C. albicans and LPS-induced NO production, and decreased LPS-induced TNFalpha production were observed in all animals with obstructive jaundice regardless of bile salt replacement. CONCLUSION: Kupffer cell function appears to be differentially affected by obstructive jaundice and these altered functions can occur independent of bacterial translocation.

Animals↗

PubMed1998

Recurrent pyogenic cholangitis.

BACKGROUND: Recurrent pyogenic cholangitis is a complex biliary tract disease characterized by intrahepatic pigment stones, endemic to Southeast Asia and seen with increasing frequency in the United States. The purpose of this study was to review the management of this disorder in a county hospital. METHODS: A retrospective review of 45 patients with recurrent pyogenic cholangitis evaluated between 1984 and 1995. The clinical and surgical management of patients with localized versus bilateral hepatolithiasis were compared. RESULTS: The prevalence of recurrent pyogenic cholangitis at our hospital has more than doubled since 1983. Fourteen of 45 patients (31%) had bilateral disease and required more abdominal computed tomography scans (P < 0.01), percutaneous cholangiograms (P < 0.05), endoscopies (P < 0.01), clinic visits (P < 0.05), and hospital admissions (P < 0.02) as compared with patients with localized disease. CONCLUSIONS: The effective treatment of recurrent pyogenic cholangitis requires definition of the patients' intrahepatic distribution of disease, prior to surgical intervention, and the coordinated efforts of gastroenterologists, radiologists, and surgeons.

Adult↗

PubMed1998

Ductal dilatation and stenting for residual hepatolithiasis: a promising treatment strategy.

BACKGROUND AND AIMS: Hepatolithiasis is prevalent in south-east Asia and presents a difficult management problem. Intrahepatic strictures with or without awkward ductal angulation of the biliary tree are the main reasons for the reported high incidence of postoperative residual stones. Without proper treatment, biliary strictures and residual stones can lead to repeated episodes of cholangitis, liver abscess, secondary biliary cirrhosis, portal hypertension, and death from sepsis or hepatic failure. The purposes of our treatment strategy were to achieve complete clearance of the stones and relief of bile stasis. METHODS: From January 1991 to July 1992, 90 patients with residual postoperative hepatolithiasis and intrahepatic strictures were treated. Postoperative ductal dilatation with percutaneous transhepatic cholangioscopy tube stenting through a mature T tube tract was performed. Choledochoscopic electrohydraulic lithotripsy was applied when impacted or large stones were encountered. RESULTS: Complete clearance of stones was achieved in 78 patients (87%). Mild haemobilia occurred in five patients (5.5%) and fever developed in seven patients (7.7%), and these patients recovered after conservative treatment. The rate of stone recurrence after a mean follow up of 43 months was 8%. Intrahepatic cholangiocarcinoma developed in one patient (1.1%). CONCLUSION: Postoperative ductal dilatation and stenting, combined with endoscopic electrohydraulic lithotripsy when indicated, is an effective and safe treatment with a low recurrence rate for complicated residual hepatolithiasis with biliary stricture.

Adult↗

PubMed1998

Serum-soluble interleukin-2 receptor concentrations in patients with breast cancer: a preliminary report.

BACKGROUND: The serum-soluble interleukin-2 receptor has been claimed to be a marker of host biological response in patients with solid malignancies. This study was designed to evaluate the biological significance of the preoperative serum-soluble interleukin-2 receptor concentration in patients with invasive breast cancer. MATERIALS AND METHODS: Venous blood samples were collected from 66 patients with invasive breast carcinoma and the serum concentrations of soluble interleukin-2 receptor were measured with an enzyme immunoassay method. Data regarding maximum tumor diameter, age, estrogen receptor status, lymph node status, distant metastasis status, histologic grade, ploidy pattern and S-phase fraction were also collected and evaluated simultaneously with the serum concentration levels of soluble interleukin-2 receptor. Fifteen age-matched healthy subjects were used as a control group. RESULTS: The mean value of serum-soluble interleukin-2 receptor in patients with invasive breast cancer was 621 +/- 145 units/ml and that of the control group was 308 +/- 59 units/ml; and the difference was significant (p = 0.000). With multivariate analysis, lymph node status (p = 0.000), distant metastasis status (p = 0.000) and maximum tumor diameter (p = 0.000) appeared as independent factors in regards to the significantly, higher serum concentrations of soluble interleukin-2 receptor. CONCLUSION: Based on our preliminary results, the preoperative serum-soluble interleukin-2 receptor concentration is closely related to lymph node status, distant metastasis status and tumor diameter in invasive breast carcinoma. This may be an additional valuable predictive factor for the diagnosis of invasive breast cancer.

Adult↗

PubMed1997

The prognostic significance of proliferating cell nuclear antigen in patients with lymph node-positive breast cancer.

OBJECTIVE: To evaluate the prognostic significance of proliferating cell nuclear antigen (PCNA) in patients with lymph node-positive primary breast cancer. DESIGN: A retrospective study. SETTING: A tertiary care hospital. STUDY PARTICIPANTS: A consecutive series of 123 patients with lymph node-positive primary breast cancer. INTERVENTION: The PCNA-labeling index [(PCNA-positive cells/1000 cells) x 100] was quantified in paraffin-embedded tissue specimens from 123 patients with lymph node-positive primary breast cancer by immunohistochemical staining. Other important clinicopathological variables, including estrogen receptor status, histological grade, lymph node status, primary tumor status, ploidy pattern, S-phase fraction, and TNM staging, were also identified and evaluated. MAIN OUTCOME MEASURES: The influence of the PCNA-labeling index on the disease-free survival rate and overall survival rate. RESULTS: The PCNA-labeling index of the tissue specimens tested from 123 patients ranged from 11% to 82%. The PCNA-labeling index was closely related to primary tumor status, histological grade, TNM staging, and S-phase fraction. Between patients with a high PCNA-labeling index (> 35%) and those with a low PCNA-labeling index (< or = 35%), there were significant (P < .01) differences in both 5-year disease-free survival rates (2% vs 85%) and 5-year overall survival rates (2% vs 92%). When the PCNA-labeling index and all the clinicopathologic variables were entered into a multivariate analysis for either disease-free survival or overall survival by the Cox proportional hazards model, the PCNA-labeling index emerged as an independent prognostic factor. CONCLUSION: Based on our results, the PCNA-labeling index potentially is a useful prognostic factor for lymph node-positive primary breast cancer.

Adult↗

PubMed1997

Single and multiple pyogenic liver abscesses: clinical course, etiology, and results of treatment.

A total of 483 patients with pyogenic liver abscess during the years 1986 to June 1995 were studied at Chang Gung Memorial Hospital in Kaohsiung: 343 were a single abscess and 140 were multiple abscesses. Males were predominantly affected by this disease. Abdominal pain was more frequent with the single abscess than with multiple abscesses, and jaundice was more frequent with multiple abscesses. Blood levels of alkaline phosphatase, bilirubin, and creatinine and the white blood cell count were significantly higher in patients with multiple abscesses than in those with a single abscess; and the hemoglobin level was higher with single abscesses. The single abscess was usually larger than 5 cm, and the multiple abscesses were usually smaller than 5 cm. The single abscess was always located on the right side (72%) and the multiple abscesses always on the right or both sides. Single abscesses mainly had a cryptogenic origin (58.9%) and multiple abscesses a biliary origin (45.0%). Liver aspirates revealed Klebsiella pneumoniae, Escherichia coli, Streptococcus, Bacteroides, Enterococcus, among others. K. pneumoniae was more often found in a single abscess and E. coli more often in multiple abscesses. Percutaneous catheter drainage and aspiration comprised the main treatment initially, and the failure rate with multiple abscesses was higher than that with single abscesses. Surgical intervention should be considered for multiple abscesses because of the underlying disease. The overall mortality with multiple abscesses (22.1%) was higher than that with a single abscess (12.8%). Partial hepatectomy produced a low mortality rate for both single and multiple abscesses and should be considered in the presence of severe hepatic destruction by an abscess or a stone.

Adult↗

PubMed1997

Serum concentration of tumor necrosis factor in patients with breast cancer.

BACKGROUND: The outcome of breast cancer is usually determined by multiple factors. Serum tumor necrosis factor alpha concentration has been found to be increased in the circulation of patients with malignancy. This study was designed with the aim to investigate any correlation between the serum tumor necrosis factor alpha and the clinicopathological features and furthermore evaluate the prognostic significance of serum tumor necrosis factor alpha concentration in breast cancer. METHODS: Forty consecutive patients with invasive breast cancer undergoing modified radical mastectomy were prospectively included and evaluated. Venous blood samples were collected before the surgery. Sera were obtained by centrifugation, and stored at -70 degrees C until assayed. The control group consisted 30 healthy, age-matched subjects. Serum concentrations of tumor necrosis factor alpha were measured by the quantitative sandwich enzyme immunoassay technique. The data on tumor size, age, estrogen receptor status, lymph node status and TNM staging were reviewed and recorded. RESULTS: The mean value of serum tumor necrosis factor alpha in patients with invasive breast cancer was 1.47 +/- 0.58 pg/ml and that of the control group was 0.98 +/- 0.37 pg/ml, and the difference was significant (P < 0.01). With univariable analysis, patients with maximum tumor size of 5 cm or larger (P = 0.03), more advanced TNM staging (P < 0.01); and more advanced lymph node status (P < 0.01) were shown to have significantly higher serum concentrations of tumor necrosis factor alpha. However, with multivariable analysis, TNM staging appeared as the only independent factor (P < 0.01) predicting the significant, higher serum concentrations of tumor necrosis factor alpha. CONCLUSION: Preoperative evaluation of serum tumor necrosis factor alpha concentrations may be a valuable parameter for reflecting the severity of staging for invasive breast cancer.

Adult↗