Improvement of glycemic control in streptozotocin-induced diabetic rats by Atlantic salmon skin gelatin hydrolysate as the dipeptidyl-peptidase IV inhibitor

In our previous study, Atlantic salmon skin gelatin hydrolysed with flavourzyme possessed 42.5% dipeptidyl-peptidase (DPP)-IV inhibitory activity at a concentration of 5 mg mL(-1). The oral administration of the hydrolysate (FSGH) at a single dose of 300 mg per day in streptozotocin (STZ)-induced diabetic rats for 5 weeks was evaluated for its antidiabetic effect. During the 5-week experiment, body weight increased, and the food and water intake was reduced by FSGH in diabetic rats. The daily administration of FSGH for 5 weeks was effective for lowering the blood glucose levels of diabetic rats during an oral glucose tolerance test (OGTT). After the 5-week treatment, plasma DPP-IV activity was inhibited; the plasma activity of glucagon-like peptide-1 (GLP-1), insulin, and the insulin-to-glucagon ratio were increased by FSGH in diabetic rats. The results indicate that FSGH has the function of inhibiting GLP-1 degradation by DPP-IV, resulting in the enhancement of insulin secretion and improvement of glycemic control in STZ-induced diabetic rats.

Association between serum ferritin and microalbuminuria in Type 2 diabetes in Taiwan

AIMS

Serum ferritin has been found closely related with diabetes and glucose metabolism, but its impact on diabetic nephropathy remains unknown. This study aimed to explore the association between serum ferritin and microalbuminuria in Type 2 diabetes.

METHODS

Eight hundred and fifty-one subjects with Type 2 diabetes were selected from a cohort participating in a glycaemic control study in Taiwan in 2008. We used urine albumin:creatinine ratio to define microalbuminuria; serum ferritin was divided into quartiles for analysis. Logistic regression and trend tests were used to delineate the association between serum ferritin and microalbuminuria.

RESULTS

Subjects with diabetes with higher ferritin tended to have more metabolic disorders, higher high-sensitivity C-reactive protein and higher prevalence of microalbuminuria. Compared with those in the lowest quartile, subjects with diabetes in the highest ferritin quartile were 55% (P = 0.029) more likely to have microalbuminuria. After controlling for demographics, metabolic profiles and other inflammatory markers, the association between serum ferritin levels and microalbuminuria remained significant (P for trend < 0.001). This independent relationship was not changed either for those who had better glycaemic control or those who had not used an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.

CONCLUSIONS

The current study shows hyperferritinemia may be an independent risk factor of nephropathy in patients with Type 2 diabetes.

THE APPLICATION OF FERRITIN-CONJUGATED ANTIBODY TO ELECTRON MICROSCOPIC STUDIES OF INFLUENZA VIRUS IN INFECTED CELLS : II. THE INTERIOR OF THE CELL

Freezing of the chorioallantoic membrane after brief fixation in formalin preserves antigenicity of cellular components and allows penetration of ferritin-conjugated antibody. Dense aggregates of viral antigen, presumed to be of the soluble type, were found in the nuclei of cells infected with influenza virus. Intracytoplasmic antigen, on the other hand, was widely dispersed. The experimental observations are consistent with the hypothesis that soluble antigen diffuses into the cytoplasm through intact nuclear membranes. Nucleoli do not appear to be the sites of antigen synthesis.

STRUCTURE AND DEVELOPMENT OF VIRUSES AS OBSERVED IN THE ELECTRON MICROSCOPE : VII. INCOMPLETE INFLUENZA VIRUS

Chicken embryos were infected by the chorioallantoic route with influenza virus, PR8 strain, in the form of undiluted chorioallantoic fluid. Electron microscopic examination 24 hours after infection revealed that membrane-bound fragments of cytoplasm appeared to be in process of release from entodermal cells of the chorioallantois. The number of such fragments was greatly increased in proportion to the number of typical viral particles after the third serial passage, which was accompanied by a reduction of the infectivity-hemagglutinin ratio (von Magnus effect). The lack of recognizable internal components, together with the presence of surface structure which closely resembled that of the virus and frequently contained viral antigen, suggested that many of these fragments were incomplete viral particles. It is proposed that concentrated inocula damage the cells and interfere with differentiation of the virus, but do not inhibit formation and detachment of cytoplasmic processes. Under these circumstances the accumulation of viral antigen at the surface of the cell will result in the predominant formation of incomplete virus.

THE APPLICATION OF FERRITIN-CONJUGATED ANTIBODY TO ELECTRON MICROSCOPIC STUDIES OF INFLUENZA VIRUS IN INFECTED CELLS : I. THE CELLULAR SURFACE

Immersion of chorioallantoic membranes infected by influenza virus in ferritin-conjugated antibody globulin prior to fixation permits recognition of viral antigen at the cellular surface. In some cases the antigen is confined to sites at which viral particles appear to be in process of release, whereas in others it is present along the entire cellular surface. During infection part or all of the cellular membrane presumably is transformed so that it contains the antigenic and structural components which coat the virus during emergence. It is suggested that detached fragments of cytoplasm possessing surface hemagglutinin but incapable of initiating infection constitute at least one form of "incomplete virus."

THE INTRACELLULAR DISTRIBUTION OF GAMMA GLOBULIN IN A MOUSE PLASMA CELL TUMOR (X5563) AS REVEALED BY FLUORESCENCE AND ELECTRON MICROSCOPY

Ferritin- and fluorescein-conjugated antibody staining has been applied to a study of a mouse plasma cell tumor. The presence of myeloma globulin within cisternae of the endoplasmic reticulum was observed at a stage of the secretory process when the remainder of the cytoplasm was essentially free of labeled globulin. The distribution of ferritin suggested a functional heterogeneity among units of the endoplasmic reticulum. Apparently, progressive accumulation of globulin results in distension of the endoplasmic reticulum and, occasionally, in the appearance of considerable quantities of this secretory protein in the extracisternal cytoplasmic matrix. Participation of the Golgi apparatus in the packaging and release of small quantitites of globulin seems likely. In addition, however, fragmentation of the peripheral cytoplasm with rupture of distended ergastoplasmic vesicles appeared to be another pathway whereby globulin is secreted.

Hematopoietic stem cell transplantation: killer immunoglobulin-like receptor component

Recognition of recipient human leukocyte antigen (HLA) class I ligand by donor natural killer cell killer immunoglobulin-like receptors (KIR) has been proposed as the basis for donor allograft reactivity against malignancy leading to reduction in posttransplant relapse and higher survival for acute myelogenous leukemia. Analysis of KIR ligand effects in 1770 patients undergoing myeloablative T-replete hematopoietic cell transplantation (HCT) from HLA-matched or mismatched unrelated donors showed that lack of KIR ligand in patients for inhibitory KIR was associated with lower hazards of relapse in leukemia patients with in HLA-mismatched transplants [hazard ratio (HR): 0.061; 95% confidence interval (CI): 0.43-0.85; P-value = 0.004]. Absence of HLA-C group 2 or HLA-Bw4 KIR ligands were each associated with lower hazards of relapse (HR: 0.47; 95% CI: 0.28-0.79; P-value = 0.004; HR: 0.56; 95% CI: 0.33-0.97; P-value = 0.04, respectively). Based on these analyses, recipient homozygosity for HLA-B or -C epitopes that define KIR ligands is likely to be a predictive factor for leukemia relapse following myeloablative HCT from unrelated donors. KIR genotyping for unrelated donors and recipients will clarify the role of these receptors in transplant outcome.

Laser-induced reorientation effect and ripple structure in dye-doped liquid-crystal films

The effects of light-induced reorientation on a homeotropical dye-doped liquid crystal (DDLC) cell are discussed. The photoexcited azo dye Methyl Red (MR) is diffused and adsorbed onto the substrate, thus forming a ripple structure. The adsorbed dye and the laser-induced ripple structure then reorient the liquid-crystal molecules and induce a holographic grating. Initially, the liquid-crystal directors are reoriented primarily by the adsorbed dye. However, given a sufficiently large ripple groove amplitude, the torque imposed by the ripple grooves overcomes that which is due to the adsorbed dyes, and the liquid crystals are realigned along the groove direction.

Humoral response to p53 in human colorectal tumors: a prospective study of 1,209 patients

p53 Antibodies (p53-Abs) have been detected in the serum of a proportion of colorectal cancer (CRC) patients. It is not yet known at which stage during colorectal tumor progression p53-Abs appear in the serum. The utility of these antibodies as markers for CRC prognosis remains to be clarified. Using a quantitative enzyme-linked immunosorbent assay, we analyzed serum samples from 998 CRC patients and from 211 patients with polyp. Levels of p53-Abs were defined as negative (<10 U/microL), low (10-76 U/microL) and high (>76 U/microL). Overall, 13.0% of CRC patients and less than 1% of polyp patients had increased serum p53-Ab levels. High p53-Ab levels were only seen in patients with invasive carcinomas. The parameters that were significantly and independently associated with a greater frequency of high p53-Ab levels were the left colon (odds ratio [OR] = 3.4; 95% CI = 1.1-10.5), the rectum (OR = 2.9; 95% CI, 1.0-8.8) and advanced lymph node metastasis (OR = 4.6; 95% CI, 2.2-9.6). In univariate analysis, patients with high p53-Ab levels had a shorter survival times than did those without (p = 0.007). However, the significant effect disappeared in a Cox regression model adjusting for sex, age, tumor location, carcinoembryonic antigen levels, gross findings, histologic grade, mucin production and TNM stage. Thus, autoantibodies against p53 occur with tumor progression in multistep colorectal carcinogenesis and increase with advanced node metastasis. Furthermore, the seemingly adverse effect of high p53-Ab levels on the survival of CRC patients may be explained by other prognostic factors.

Phase II study of a weekly 8-hour 5-fluorouracil and leucovorin infusion for patients with advanced colorectal cancer: dose adjusted according to its toxicity

BACKGROUND

5-fluorouracil (5-FU) clearly behaves as two different drugs according to the schedules for its administration. A weekly, 8-h 5-FU continuous infusion (CI) regimen may produce a dual effect, because it elicits both a high plasma 5-FU level and also a durable exposure to 5-FU, which may have the advantage of inhibiting both DNA synthesis and RNA activities. The plasma 5-FU level, however, cannot be monitored in most hospitals, so we initiated a pragmatic clinical trial with this weekly 8-h 5-FU Cl regimen and adjusted the drug's dose according to the detected toxicity.

METHODS

The initial dose of 5-FU was 1200 mg/m2 and this was escalated by 200 mg/m2 weekly, provided that no evidence of significant (grade 2 or greater) toxicity became apparent. Twenty-six patients entered the study from June 1998 to March 1999.

RESULTS

The median dose of 5-FU delivered was 1600 mg/m2. The major symptoms precluding dose escalation were nausea and vomiting. Seven patients demonstrated a partial response (26.9%), 11 patients revealed stable disease (42.3%) and eight exhibited progressive disease (30.8%).

CONCLUSION

This weekly 8-h CI 5-FU protocol with the adjustment of dose according to toxicity was not able to achieve the same 5-FU dose and response rate as in previous studies with pharmacokinetic monitoring of 5-FU levels. However, with the concurrent administration of intensive anti-emetic premedication, it is still possible to achieve adequate plasma 5-FU levels by adjusting the 5-FU dose according to elicited toxicity.

Dynamic studies of holographic gratings in dye-doped liquid-crystal films

The dynamic behavior of a holographic grating induced in a homeotropically aligned dye-doped liquid-crystal film is investigated. In the presence of an applied dc voltage, photoexcited azo dyes induce a photorefractive grating and then diffuse and are adsorbed onto cell substrates. The reorientation of liquid crystals as a result of adsorbed dyes leads to a phase grating that is phase shifted 90 degrees from the photorefractive grating. Competition of these two gratings induces two-beam coupling of the writing beams, initially transferring energy from beam 1 to beam 2 and then, after a pause, from beam 2 to beam 1.

Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients

OBJECTIVE

To identify the risk factors for surgical site infection (SSI) in patients undergoing elective resection of the colon and rectum.

SUMMARY BACKGROUND DATA

SSI causes a substantial number of deaths and complications. Determining risk factors for SSI may provide information on reducing complications and improving outcome.

METHODS

The authors performed a prospective study of 2,809 consecutive patients undergoing elective colorectal resection via laparotomy between February 1995 and December 1998 at a single institution. The outcome of interest was SSI, which was classified as being incisional or organ/space with or without clinical leakage. A likelihood ratio forward regression model was used to assess the independent association of variables with SSIs.

RESULTS

The overall SSI, incisional SSI, and organ/space SSI with and without clinical anastomotic leakage rates were 4.7%, 3%, 2%, and 0.8%, respectively. Risk factors for overall SSI were American Society of Anesthesiology (ASA) score 2 or 3 (odd ratio [OR] = 1.7), male gender (OR = 1.5), surgeons (OR = 1.3-3.3), types of operation (OR = 0.3-2.1), creation of ostomy (OR = 2.1), contaminated wound (OR = 2.9), use of drainage (OR = 1.6), and intra- or postoperative blood transfusion (1-3 units, OR = 5.3; >/=4 units, OR = 6.2). However, SSIs at specific sites differed from each other with respect to the risk factors. Among a variety of risk factors, only blood transfusion was consistently associated with a risk of SSI at any specific site.

CONCLUSIONS

In addition to ASA score and surgical wound class, blood transfusion, creation of ostomy, types of operation, use of drainage, sex, and surgeons were important in predicting SSIs after elective colorectal resection.

Changes in K value and microorganisms of tilapia fillet during storage at high-pressure, normal temperature

This study determined the effect of high-pressure, normal temperature (25 degrees C) storage on tilapia fillets. After pressurization, the fillets were stored at normal condition (1 atm [1 atm = 101.29 kPa] and 25 degrees C) for 12 h to evaluate the changes of microbes and K value. The fillets stored at 2,000 atm for 12 h still kept the K value, a freshness index that represents putrefaction with the value beyond 60%, still below 40%, and the K value of the meat without pressurization was up to 92%. Total plate counts of the fillets stored at below 1,000 atm for 12 h were maintained at the value of 4.7 log CFU/g of meat, which was similar to the initial level. However, the counts were obviously decreased to about 2.0 log CFU/g of meat for the fillets stored at above 2,000 atm. The same effect was obtained for psychrophilic bacteria. Enzymes and microbes reactivated apparently after 12 h of normal condition storage of mild pressurized fillets. The study demonstrates that high-pressure storage can inhibit the putrefaction of tilapia meat but no longer after that.

Mitochondrial DNA phylogeography of Acrossocheilus paradoxus (Cyprinidae) in Taiwan

Nucleotide sequences of 3' end of the cytochrome b gene, tRNA genes, D-loop control region, and the 5' end of the 12S rRNA of mitochondrial DNA (mtDNA) were used to assess the genetic and phylogeographic structure of Acrossocheilus paradoxus populations, a Cyprinidae fish of Taiwan. A hierarchical examination of populations in 12 major streams from three geographical regions using an analysis of molecular variance (AMOVA) indicates high genetic differentiation both among populations (PhiST = 0.511, P < 0.001) and among regions (PhiCT = 0.368, P < 0.001). Limited migration largely contributed to the genetic differentiation. High nucleotide diversity (1.13%) and haplotype diversity (0.80%) were detected among populations. The degree of genetic differentiation was correlated with geographical distance between populations, a result consistent with the one-dimensional stepping stone models. A neighbour-joining tree recovered by (DAMBE) supports the pattern of isolation by distance and reveals a closer relationship between populations of the central and southern regions. A minimum spanning network based on nucleotide substitutions reflected migration routes from populations of the central region to the northern and southern regions, respectively. Postglacial colonization and expansion can explain the phylogeographical pattern. Single and ancient migration events may have allowed the northern region to attain the monophyly of mtDNA alleles. In contrast, most populations within geographical regions are either paraphyletic or polyphyletic due to the relatively shorter time period for coalescence. Both low haplotype number and genetic variability suggest a bottleneck event in the Chingmei population of northern Taiwan. Based on coalescence theory, the monophyly of the Tungkang population of the southern region may be associated with a founder event.

Primary colorectal lymphoma

PURPOSE

The purpose of this study was to review the clinical presentation and characteristics of primary colorectal lymphoma, analyze the prognostic factors, and assess the results of treatment with adjuvant chemotherapy.

METHODS

We identified 37 cases at our institution between 1980 and 1996. They comprised 0.48 percent of all cases of colon malignancies (37/7,658) during this period. The following clinical information was obtained: age, gender, signs and symptoms, tumor site, tumor size, histology grade, pathology, and adjuvant chemotherapy.

RESULTS

The most common presenting signs and symptoms were abdominal pain (62 percent), abdominal mass (54 percent), and weight loss (43 percent). The most frequent site of involvement was the cecum (45 percent). Histologically, 29 (78 percent) were classified as high-grade, and 8 (22 percent) as intermediate-grade-to-low-grade lymphoma. Nine (24.3 percent) of the cases were Stage EI, 23 (62.2 percent) were Stage EII, and 5 (13.5 percent) were Stage EIV. Twenty-one (57 percent) cases received adjuvant chemotherapy. The five-year survival rate was 33 percent for all patients and 39 percent for patients treated with combination chemotherapy. Overall median survival time was 24 months and 36 months for those with adjuvant chemotherapy. Only histology grade, among the factors examined, was a significant prognostic factor for survival. The mean survival time of the patients with Stage II disease who received chemotherapy was 117.4 months, and it was 47.9 months for the patients with Stage II disease who did not received chemotherapy.

CONCLUSIONS

In our retrospective study high-grade lymphoma was the only significant adverse prognostic factor for survival. Receiving adjuvant chemotherapy significantly improved survival in patients with Stage II disease. Patients with diffuse large-cell type had better survival than patients with small noncleaved-cell type in Stage II high-grade lymphoma.

Colon carcinoma with synchronous ovarian metastasis--report and discussion of five cases

Ovarian metastasis may present at the time of initial diagnosis of colon carcinoma or as a later recurrence. Little meaningful information is available regarding the treatment and outcome of synchronous ovarian metastasis of colon carcinoma. This report describes the clinical course of five patients with synchronous ovarian metastasis of colon carcinoma who were treated with aggressive surgery and chemotherapy. The treatment consisted of maximal surgical debulking followed by systemic chemotherapy with weekly 24 h infusion of high-dose 5-fluorouracil and leucovorin. All of the five patients had subsequent disease-free periods ranging from 6 to 43+ months following operation. Two of the patients who had no or minimal peritoneal involvement were still alive without disease at 33 and 43 months. The data from these cases suggest that aggressive surgery and systemic chemotherapy may be highly efficacious in the treatment of colon carcinoma with synchronous ovarian metastasis. Maximal debulking followed by chemotherapy may be particularly effective in those patients with minimal peritoneal involvement.

A simplified regimen of weekly high dose 5-fluorouracil and leucovorin as a 24-hour infusion in patients with advanced colorectal carcinoma

BACKGROUND

Reports of in vitro experiments in colorectal carcinoma cells suggest that prolonged cellular exposure to 5-fluorouracil (5-FU) combined with relatively low concentrations of leucovorin (LV) provides optimal enhancement of 5-FU efficacy. In this study, a simplified regimen of weekly 24-hour infusion of high dose 5-FU combined with a relatively low dose of LV was used to treat patients with advanced colorectal carcinoma.

METHODS

Thirty-six patients with advanced colorectal carcinoma received 5-FU, 2600 mg/m2, admixed with LV, 100 mg/m2, in a portable infusion pump administered intravenously over a 24-hour period. High dose 5-FU/LV was delivered once a week for 5 consecutive weeks followed by a 1-week recovery period. All patients were assessable for toxicity and response.

RESULTS

Two complete responses and 15 partial responses were observed (response rate of 47.2%; 95% confidence interval, 30.1-64.4%). The median response duration was 9.6 months. The median survival and time to progression were 11.9 months and 7.1 months, respectively. The toxicity was mild and acceptable. The major dose-limiting factors were hand-foot syndrome and fatigue.

CONCLUSIONS

This simplified regimen of weekly 24-hour continuous infusion of high dose 5-FU/LV is an effective regimen in the treatment of patients with advanced colorectal carcinoma. Further study of the pharmacokinetics of combination therapy with 5-FU and LV as used in this regimen and its correlation with response and toxicity is warranted.

[Vancomycin-resistant enterococci in north-eastern Taiwan]

Vancomycin-resistant enterococci (VRE) is a world-wide emerging pathogen. The first confirmed VRE isolate in Taiwan was detected in 1995. After that, more and more isolates of VRE were found in western part of Taiwan. However, before this report, there was no any isolate of VRE found in eastern part of Taiwan. In December 1997 and January 1998, two cases of VRE urinary tract infection were found in two regional hospitals in north-eastern Taiwan. They had received prolonged treatment with multiple antibiotics for other infections before they got VRE infection. The isolates showed susceptibility to other antimicrobial agents by routine disk diffusion susceptibility test and these two patients were successfully treated. The VRE did not spread in those two hospitals. After further study, the 3 isolates from these two patients all had minimum inhibitory concentration of vancomycin >256 microg/mL. They all carried van A gene and the pulsed-field gel electrophoresis demonstrated they belonged to different DNA types. It was concluded that VRE appeared in north-eastern Taiwan but the strains were not from a common source.

Identification of novel genes that are differentially expressed in human colorectal carcinoma

By using mRNA differential display technology, we have identified three cDNA clones, myl 3, myl 4, and myl 6, to show significant changes in expression between human colorectal tumor and paired normal tissue. Northern blot analysis indicated that clone myl 3 expression was elevated in normal tissue, and clone myl 4 expression was elevated in tumor tissue. Nucleotide sequence analysis revealed that clones myl 3 and myl 4 have not been previously identified. However, clone myl 6 appears to be the human homolog of the 3' end region of tissue inhibitor of metalloproteinase 3 (TIMP-3). Northern blot analysis showed that a 2.5 kb TIMP-3 transcript was expressed at a much higher level in normal tissue than the colorectal tumor.

Segmental colectomy in the management of colonic inertia

Subtotal colectomy with ileorectostomy has been proposed for the management of colon inertia-type constipation. However, many patients experience frequent bowel movements, watery diarrhea, or both after such a treatment. The purpose of this study is to determine the proper colectomy with which to treat colon dysmotility constipation without the negative side effects of frequent bowel movements, watery diarrhea, or both. Forty idiopathic constipation patients were studied. All of the patients showed a prolonged right or left colon transit time and normal transit time of the sigmoid and rectum. They received different types of colectomies (left, right, and subtotal) according to the distribution or accumulation of markers in the colon. Within 3 months of surgery, all of the patients experienced a dramatic improvement of their symptoms without frequent bowel movements or watery diarrhea. No significant complications developed after surgery. All the patients were followed up for at least 2 years. Most of them (37 cases) still had satisfactory bowel movements and no other constipation symptoms. However, 3 of the 40 cases developed symptoms of constipation 1 1/2 to 2 years after surgery. They all received subtotal colectomy with ileorectal anastomosis subsequently. They reobtained satisfactory bowel movements and experienced a subsidence of other constipation symptoms 3 months later. These results suggest that directed segmental colectomy can improve colonic inertia constipation without the consequence of frequent bowel movements and diarrhea.

Primary diffusely infiltrative adenocarcinoma of the colon and rectum

BACKGROUND

Primary diffusely infiltrative colorectal adenocarcinoma is rare. About 100 cases have been reported in the literature. The mucosal alterations in this type of tumor and their clinicopathological characteristics in relation to survival are not clear.

METHODS

We retrospectively reviewed 30 cases of primary diffusely infiltrative colorectal adenocarcinoma operated upon in a single institution.

RESULTS

Eighteen (60%) of these 30 patients were women. The average age at diagnosis was 47.4 (SD, 19.3) years. Eighteen tumors (60%) were located in the rectum. The tumors could be classified into two major types. A type 1 tumor had minimal mucosal alteration and no discrete ulcer. A type 2 tumor was associated with a discrete ulcer. The type 1 tumor was more frequently associated with intracellular or extracellular mucin production and stage IV disease. Hematogenous spread (including peritoneal carcinomatosis) was more frequently seen in type 1 than in the type 2 tumors (61% vs. 18%, p = 0.013). The overall median cancer-specific survival time was 15 (SE, 3; 95% confidence interval, 10-21) months. TNM stage is the only significant factor in predicting outcome (p = 0.016). When compared with stages II and III, the odds of death for stage IV was 2.9 (95% confidence interval: 1.1-7.4).

CONCLUSION

Diffusely infiltrative colorectal cancer can be separated into two subtypes according to the presence of a discrete ulcer. The type 1 tumor (without a discrete ulcer) was associated with a higher frequency of hematogenous spread. TNM Stage was the only important clinicopathological factor in determining outcome.

Resection of liver metastases from colorectal cancer: are there any truly significant clinical prognosticators?

PURPOSE

This study was designed to evaluate the prognostic significance of various prognostic factors affecting recurrence after resection of colorectal hepatic metastases.

PATIENTS AND METHODS

Records of 54 patients who had hepatic resection between 1986 and 1993 for metastatic liver tumor from colorectal cancer were reviewed. Factors analyzed were those reported to be of prognostic significance in other studies, including gender, primary tumor site, Dukes stage, diagnostic interval, grade, preoperative carcinoembryonic antigen (CEA) level, number of metastases, size of metastases, distribution of metastases, type of resection, resection margin, and estimated blood loss.

RESULTS

Average follow-up of surviving patients was 28 (range, 12-89) months. Average survival time from date of hepatic resection was 26 months, with an estimated actuarial survival rate of 25.5 percent at five years. Using the multivariate analysis of factors, gender and preoperative CEA level were shown to be significantly related to overall survival (P = 0.0455 and 0.054, respectively). Cancer of the right side colon had significant correlation with hepatic "recurrence" (P = 0.0071).

CONCLUSIONS

Female patients and those with peroperative CEA values higher than 20 ng/ml have a better chance of survival following hepatic resection. Cancer of the right colon has a greater tendency for hepatic recurrence than that of the left colon.

Reversal of the surface charge asymmetry in purple membrane due to single amino acid substitutions

Twenty-seven mutant bacteriorhodopsin's were screened to determine the PKa for reversal of the permanent electric dipole moment. The photoelectric response of an aqueous purple-membrane suspension was used to determine the direction of the purple-membrane dipole moment as a function of pH. The pK(a) for the dipole reversal of wild-type bacteriorhodopsin is 4.5. Six of the 27 mutant bacteriorhodopsin's were found to have a pK(a) for dipole reversal larger than that of wild-type bacteriorhodopsin. Two of these mutants, L93T and L93W, involve a neutral amino acid substitution in the interior of the protein. The direction of the purple-membrane permanent electric dipole moment is determined by the purple-membrane surface charge asymmetry. We conclude that these two substitutions, which do not involve charge replacement, alter the pK(a) for the reversal of the purple-membrane surface charge asymmetry. We suggest that these changes to the pK(a) are due to altered protein folding at the surface of the purple-membrane induced by single-site substitutions in the protein interior.

Prognostic evaluation of DNA flow cytometric and histopathologic parameters of colorectal cancer

BACKGROUND

The clinical value of DNA flow cytometry of colorectal cancer is unclear. The purpose of this retrospective study was to evaluate the relationship between tumor flow cytometry, histopathologic parameters, and survival.

METHODS

Flow cytometry was performed on paraffin embedded specimens from 653 patients who had surgery from 1980 to 1983.

RESULTS

Aneuploidy was associated with distal tumor, perineural invasion, desmoplastic reaction, and failure to secrete mucin. TNM Stage I tumors were more frequently diploid than were more advanced tumors (71% vs. 41%). An abnormal DNA content had a marginal impact on survival as evaluated by univariate analysis (69% vs. 61% 10-year survival rate, P = 0.06). Multivariate analysis revealed that significant predictors of outcome were lymph node metastasis (95% confidence interval of relative risks of death from recurrent disease, 1.50-2.92), rectal cancer (1.22-2.19), absence of lymphocytic infiltration (1.20-2.17), invasion through bowel wall (1.17-3.13), lymphatic vessel invasion outside bowel wall (1.05-2.69), perineural invasion (1.15-3.19), and male gender (1.00-1.79).

CONCLUSIONS

These findings suggest that ploidy is associated with some histopathologic parameters, but flow cytometry does not correlate with long term survival of patients with colorectal carcinoma.

Survival impact of lymph node metastasis in TNM stage III carcinoma of the colon and rectum

BACKGROUND

Node-positive (TNM stage III) adenocarcinoma of the colon and rectum consists of tumors with a widely variable prognosis. To predict the outcome of patients with stage III carcinoma, we assessed the survival impact of the number and level of lymph node metastasis and other clinicopathological variables.

STUDY DESIGN

A retrospective study was performed on 538 patients with stage III carcinoma of the colon and rectum who underwent curative resection at Chang Gung Memorial Hospital between 1980 and 1989. Ten or more lymph nodes in each resected specimen were identified microscopically. Multivariate analysis was used to determine the independent variables.

RESULTS

The relative survival rates at five and ten years were 52 and 42 percent, respectively. Tumor morphology, depth or tumor penetration, histologic grade, and the status (number and level) of nodal involvement were significant in the univariate analyses. Only grade and nodal status remained significant in the multivariate analysis. Based on the nodal status, these patients were separated into three groups: stage IIIA (one to three positive nodes and absence of pN3 metastasis), IIIB (four to nine nodes and absence of pN3), and IIIC (ten or more nodes or presence of pN3). The five-year survival rates for patients with stages IIIA, IIIB, and IIIC disease were 69, 44, and 29 percent, respectively. Compared with patients with stage IIIA disease, the odds of death for patients with stages IIIB and IIIC carcinoma were 2.1 (95 percent confidence interval: 1.5 to 2.8, p = 0.0001) and 3.3 (95 percent confidence interval 2.4 to 4.5, p = 0.001), respectively.

CONCLUSIONS

We suggest that stage III adenocarcinoma of the colon and rectum be divided into three substages: IIIA (one to three positive nodes and absence of pN3 metastasis), IIIB (four to nine nodes and absence of pN3), and IIIC (ten or more positive nodes or presence of pN3.

Presacral tumor: a review of forty-five cases

Forty-five patients with primary presacral tumors underwent their treatment at Division of Colon Rectal Surgery, Chang Gung Memorial Hospital, from 1978 to 1992. These 45 patients, 20 male and 25 female, ranged from 15 to 76 years of age (mean, 41.1 years). Congenital tumors (47 per cent) were the most frequent histologic type, followed by miscellaneous tumors (36 per cent). Forty-eight per cent of patients had malignant tumors. All benign congenital cysts were in females. These tumors presented a variety of symptoms and signs. Diagnosis could be made by digital examination in 43 (96 per cent) of the patients. Computed tomographic scan was the most important diagnostic tool in determining the extent and degree of tumor invasion. The positive rate was 100 per cent in 21 patients. As for operative methods, abdominal approach was selected in 24 patients, transacral in 13 patients, abdominal/sacral combined in 6 patients, and biopsy only in two patients. Postoperative complications occurred in 16 patients (36 per cent), but there were no operative deaths. Of the tumors that underwent resection, 23 had total resection (18 benign and 5 malignant) and 22 incomplete (5 benign and 17 malignant). Benign tumors had a good chance with resection of the lesion (P < 0.05). For patients with malignant tumors, the 5-year survival rate was 40.7 per cent. Whenever possible, total resection could offer better results for presacral tumor, whether the lesions were benign or malignant.

Upregulation of NF-kappa B-dependent gene expression mediated by the p75 tumor necrosis factor receptor

Tumor necrosis factor (TNF-alpha) interacts with two transmembrane receptor proteins, p55TNFR and p75TNFR, which are members of a family of cell surface molecules that include the Fas antigen, CD27, CD30, CD40, OX40, a Shope fibroma viral protein, and the low-affinity p75 neurotrophin receptor. Although the p55 TNF receptor has been shown to be primarily responsible for the biologic responses of TNF-alpha, the exact involvement of the p75 TNF receptor in signaling events is unclear. Here we show that expression of a human cDNA clone for p75 in COS-1 and 3T3 cells results in the constitutive activation of an TNF-inducible NF-kappa B-containing promoter. Analysis of a number of chimeric p75 receptor cDNA constructs further suggests that this activity requires the cytoplasmic domain of the p75 receptor. These results therefore indicate that the p75 TNF receptor is capable of mediating signal transduction.

Glomus tumors of the upper extremity: experience with twelve cases

BACKGROUND

The glomus tumor is an uncommon tumor of the hand, which presents with much pain. It is a benign neoplasm composed of a glomus body, which is located in the dermis. Glomus tumors present a classic clinical picture of pain, sensitivity to cold and local tenderness over the lesion.

METHODS

Twelve patients underwent surgical removal for glomus tumors of the upper extremity from 1983 to 1992. There were three males and nine females; their average age was 37 years (25 to 60 years). The clinical manifestations were pain and local tenderness in 12 patients, and cold intolerance in 6 patients.

RESULTS

There was a difference in gender in the anatomical site of the tumor. In three male patients, only one tumor was found in the digit. In female patients, all nine tumors were located in the digits. The average tumor size was 0.6 cm in diameter. After follow-up of 4.5 years (average), no recurrence, no residual pain or cold intolerance was noted.

CONCLUSIONS

The treatment of glomus tumor consisted of local excision or curettage, with or without reconstruction of the nail bed. Recurrence is not a problem after complete removal of the tumor tissue. Permanent nail deformity is still a problem. Efforts to prevent this sequelae are worth trying.

Fibrodysplasia (myositis) ossificans progressiva

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary connective tissue disorder. Patients with FOP develop progressive ossification of muscle and connective tissue associated with pain and disability. Onset is typically in childhood, and congenital anomalies of the feet are an early sign of this condition. Pain and stiffness of the spine or an inflammatory mass are common presenting features of FOP. Involvement of the spine often leads to complete fusion mimicking ankylosing spondylitis. Studies of twins and families suggest that FOP is a genetically inherited autosomal dominant trait with complete penetrance but variable expressivity. While radionuclide imaging and computed tomography are very sensitive for new bone formation and greatly assist the diagnosis of FOP, unfortunately, effective therapy is unavailable. We present twins with FOP and review the clinical, radiographic, and genetic manifestations of this disorder.

A human tumor necrosis factor (TNF) alpha mutant that binds exclusively to the p55 TNF receptor produces toxicity in the baboon

A number of recent studies have demonstrated that cellular responses to tumor necrosis factor (TNF) mediated by the p55 and the p75 TNF receptors are distinct. To evaluate the relative in vivo toxicities of wild-type TNF alpha (wtTNF alpha) and a novel p55 TNF selective receptor agonist, healthy, anesthetized baboons (Papio sp.) were infused with a near-lethal dose of either wtTNF alpha or a TNF alpha double mutant (dmTNF alpha) that binds specifically to the p55, but not to the p75, TNF receptor. Both wtTNF alpha and dmTNF alpha produced comparable acute hypotension, tachycardia, increased plasma lactate, and organ dysfunction in Papio. However, administration of wtTNF alpha produced a marked granulocytosis and loss of granulocyte TNF receptors, whereas little if any changes in neutrophil number or cell surface TNF receptor density were seen after dmTNF alpha mutant administration. Infusion of dmTNF alpha resulted in a plasma endogenous TNF alpha response that peaked after 90-120 min. We conclude that selective p55 TNF receptor activation is associated with early hemodynamic changes and the autocrine release of endogenous TNF alpha. Significant systemic toxicity results from p55 TNF receptor activation, but the role of the p75 TNF receptor in systemic TNF toxicity requires further study.

Diffuse pigmented villonodular synovitis of the shoulder: a case report

Pigmented villonodular synovitis (PVNS) of the shoulder is an uncommon disorder with unknown etiology. It is characterized by synovial proliferation and hemosiderin deposition into the synovial tissues of the affected joints. PVNS affects mainly the knee joint and shoulder involvement is rare. There are only 12 cases of shoulder involvement reported in the English-language literature. A case of PVNS of the shoulder with simultaneous rotator cuff tear is presented and the literature is reviewed.

Two to five year follow-up of Harris-Galante cementless total hip arthroplasty

One hundred and forty-nine hips (125 patients) underwent cementless Harris-Galante primary total hip arthroplasty from September 1987 to June 1990 at the Taichung Veterans General Hospital. Seventy hips (61 patients) have been followed up for at least 2 years (range, 26-55 months, mean 36 months). The primary diagnoses included osteoarthritis (42.9%) and avascular necrosis (57.1%). All the hips were evaluated using Harris hip score and Mayo Clinic hip score. The average Harris hip score was 36.5 points (23-73) preoperatively, and 95 points (80-100) postoperatively. When evaluated by the Harris hip score, 94.3% were excellent, and 5.7% had good results; and 90% were excellent, 10% had good results when evaluated by Mayo Clinic hip score. No fair or poor results were noted by either evaluating system. Fifty-seven femoral components (81.4%) appeared to have stable bone ingrowth fixation, ten components (14.3%) had stable fibrous ingrowth, and three (4.3%) were unstable. Fifty-five hips (78.6%) showed radiolucent lines around the femoral component in follow-up roentgenogram; most were at the non-porous, fiber-mesh part. It seemed that there was no correlation between these radiolucent lines and clinical outcome, according to this short-term study.

Differential expression and ligand binding properties of tumor necrosis factor receptor chimeric mutants

The receptors for tumor necrosis factor (TNF) are represented by two transmembrane proteins, p55TNFR and p75TNFR, which are members of a family of cell surface molecules, including the Fas antigen, CD30, CD40, OX40, a Shope fibroma virus protein, and the low affinity p75 nerve growth factor receptor. A common structural feature is a sequence of 40 amino acids that is found in adjacent repeated domains, with 6 cysteine residues in a conserved register. To assess the functional significance of this cysteine-rich domain (CRD), we have constructed chimeric receptors between each TNF receptor and the low affinity nerve growth factor receptor. The chimeric receptor cDNAs were expressed efficiently in COS-1 and 3T3 fibroblasts, as assessed by affinity cross-linking, cell surface biotinylation and immunoprecipitation, and equilibrium binding. Receptors with two CRD of either TNF receptor were incapable of binding TNF, whereas receptors with all four CRD retained the ability to bind TNF with wild type affinity. These results, in conjunction with previous deletion mutation studies, suggest that TNF binding to each receptor requires all four cysteine-rich repeats. Furthermore, analysis of chimeric receptors containing domains of p55TNFR suggests that cytoplasmic sequences directly influence the levels of receptor expression.

Pigmented villonodular synovitis

Seventy-three patients, 28 males and 45 females, diagnosed with pigmented villonodular synovitis (PVNS) between 1982 and 1990 were followed for an average of 42.2 months (range, 21 to 108 months). Fifty-five cases occurred in the tendon sheath and eighteen in synovial joint. Ages ranged from 5 to 77 years, with an average of 38.9 years. The clinical presentations included chronic tumescence, serosanguinous arthrocentesis and painful limitation of range of motion. Plain roentgenography usually demonstrated soft tissue swelling with varying density, bony erosion or joint space narrowing. Arthrography and magnetic resonance imaging both gave specific pictures, with good diagnostic rates. The therapeutic regimen consisted of marginal excision for tendon sheath lesions and total synovectomy for intraarticular lesions. Extensive synovectomy with prosthesis replacement yielded good functional results in elderly patients with PVNS and cartilage destruction. Recurrence rate averaged 26% and was higher among knee joint lesions (33%), possibly because of inaccessibility of the popliteal fossa and inadequate excision of the lesion. Differences in the mitotic index between recurrence and non-recurrence groups had no statistical significance. This phenomenon may well serve against "tumor origin" as the etiology of this disease.

An alternative treatment of anal squamous cell carcinoma: combined radiotherapy and chemotherapy

The conventional surgical treatment of anal squamous cell carcinoma is abdominoperineal resection. A new approach of combined radiotherapy and chemotherapy has been proposed following the observation of excellent local control. In this retrospective study, 40 cases of primary anal squamous cell carcinoma without distant metastasis were collected between 1979 and 1986 and the individual prognosis of the above two methods of treatment was evaluated. Group I (20 cases) received abdominoperineal resection with or without postoperative radiotherapy. Postoperative radiation was given if regional lymph node biopsy was positive. Group II (20 cases) received combined radiotherapy and chemotherapy with or without wide local excision. Radiation was delivered to the anus, pelvis, and bilateral inguinal nodal areas to a total dose of 5,500 rads. A continuous infusion of 5-FU was started on day 2 of the irradiation at a dose of 1,000 mg/m2 body surface/day for 5 days and a bolus injection of mitomycin was given on day 2 at a dose of 10 mg/m2 body surface. The second course was given 1 month later to complete the chemotherapy. The wide local excision was performed if the disease still persisted after completion of combined radiotherapy and chemotherapy. All 40 cases were followed up for at least 5 years. All cases (100%) in group I survived 1 year, 18 cases (90%) 2 years, 14 cases (70%) 3 years, 10 cases (50%) 4 years, and 6 cases (30%) 5 years. Twenty cases (100%) in group II survived 1 year, 17 cases (85%) 2 years, 13 cases (65%) 3 years, 8 cases (40%) 4 years, and 5 cases (25%) survived 5 years. All the mortalities in both groups died of distant metastasis or abdominal carcinomatosis. From the above results, the overall survival rate of combined radiotherapy and chemotherapy was not significantly worse than that of conventional abdominoperineal resection. In conclusion, combined radiotherapy and chemotherapy may be chosen as an alternative management in treating anal squamous cell carcinoma.

Activation-induced ubiquitination of the T cell antigen receptor

The zeta subunit of the T cell antigen receptor (TCR) exists primarily as a disulfide-linked homodimer. This receptor subunit is important in TCR-mediated signal transduction and is a substrate for a TCR-activated protein tyrosine kinase. The zeta chain was found to undergo ubiquitination in response to receptor engagement. This posttranslational modification occurred in normal T cells and tumor lines. Both nonphosphorylated and phosphorylated zeta molecules were modified, and at least one other TCR subunit, CD3 delta, was also ubiquitinated after activation of the receptor. These findings suggest an expanded role for ubiquitination in transmembrane receptor function.

Bronchiolitis obliterans organizing pneumonia and scleroderma

Pulmonary involvement in scleroderma is characterized by interstitial fibrosis and pulmonary hypertension. Although bronchiolitis obliterans organizing pneumonia (BOOP) may be associated with a variety of connective tissue diseases and their treatment, there are only rare reports of bronchiolitis associated with scleroderma. We describe 2 patients with scleroderma and rapidly evolving pulmonary infiltrates, which upon biopsy showed histologic findings of BOOP. Each patient had severe restrictive lung disease and markedly diminished diffusion capacity. Treatment with high dose prednisone showed a good response in one patient. The rapid course of pulmonary findings in these patients differs from the usual course of pulmonary fibrosis in scleroderma. Although BOOP is a rare finding in scleroderma, our findings suggest that rapid pulmonary decompensation or atypical findings for pulmonary fibrosis should prompt consideration for an open lung biopsy. Finding a potentially steroid responsive disorder in an otherwise steroid unresponsive disorder has important clinical implications.

[Experience of surgical treatment for colorectal endometriosis: report of 6 cases]

Endometriosis is a common disease with 8-15% occurrence in women during their reproductive period. Involvement of the bowel wall occurs rather frequently and probably presents in 12-34% of patient with pelvic endometriosis. However, it is classically asymptomatic and difficult to find out. From 1977 to 1987, we had six patients of colorectal endometriosis with mainly bowel symptoms. Five of them were located at rectum and sigmoid colon, one at the hepatic flexure of colon. All of the cases developed constipation or diarrhea, and four of them had severe abdominal pain. Four cases developed rectal bleeding. Previous operation for pelvic endometriosis was noted in two cases. The detailed examination included digital examination, endoscopy, barium enema and CT scan. Suspected malignancy was the indication for surgery in 4 cases and one in rectal stenosis. Low diagnostic rate was due to the fact that endometrial tissue rarely infiltrates the mucosa. Therefore, pathology of biopsied specimen often reveals non-conclusive finding to prevent differential diagnosis. However bowel resection offers conclusive diagnosis and chances of cure. In our study, only one suspected endometriosis case received bilateral oophorectomy. The stenotic segment of rectum restored to normal caliber after operation.

Shoulder problems in the weekend athlete

With more competitive and recreational athletic pursuits now being undertaken by an aging population, the painful shoulder is seen frequently in the weekend athlete. Episodic stresses to soft-tissue restraints and musculotendinous units around the shoulder lead to a variety of overused pathologic entities. The two most common shoulder problems in the weekend athlete are irritation, swelling, and mechanical impingement; and tearing of the rotator cuff with traumatic shoulder instability (typically of an anterior direction).

Molecular Genetic Analysis of HLA—DR and HLA—DQ Genes Among Anti—U1-70-kd Autoantibody Positive Connective Tissue Disease Patients

OBJECTIVE

We have recently found that the presence of autoantibodies against the 70-kd polypeptide of U1 RNP (U1-70-kd) is associated with HLA-DR4 and DR2. To further characterize this association, we performed a molecular genetic analysis of HLA-DR and DQ genes among patients with autoantibodies against U1-70-kd.

METHODS

The polymerase chain reaction (PCR), sequence-specific oligonucleotide hybridization, and solid-phase direct DNA sequencing of PCR-amplified DNA were utilized to analyze HLA-DRB1, DRB5, DQA1, and DQB1 genes.

RESULTS

A comprehensive analysis of HLA-DRB1, DRB5, DQA1, and DQB1 from 27 patients and controls identified shared amino acids FDYFYQA (Phe, Asp, Tyr, Phe, Tyr, Gln, Ala) at positions 26, 28, 30-32, 70, and 73 of HLA-DRB1 on disease-associated haplotypes.

CONCLUSION

A common cluster of shared amino acids, or a shared epitope, identified within HLA-DRB1 among anti-U1-70-kd autoantibody positive connective tissue disease patients may be important in regulating an autoimmune response to the U1-70-kd antigen.

Prognostic factors in management of traumatic perforation of colon and rectum

A retrospective analysis was made of the prognostic factors and management of traumatic perforation of the colon and rectum in 80 patients during the period of 1980 to 1988 at Chang Gung Memorial Hospital. The total mortality was 11%. Morbidity was 18% among the survivors. The mortality was higher in patients with old age (50% for those over 60 years old), delayed operation (50% for a delay of more than 72 hours), poor nutrition (57%), shock condition before or during operation (50%), severe abdominal fecal contamination (35%) and associated abdominal injury. We conclude that the surgical procedures for traumatic perforation of colon and rectum performed depend upon the patient's condition. The prognostic factors in patients with traumatic perforation are patient's age, timing of operation, degree of abdominal fecal contamination, injury to other abdominal organs and general condition such as nutrition and shock.

[Acetabular roof reconstruction with femoral head bone-graft for severe acetabular deficiency in total hip replacement]

From July 1984 to September 1989 at Taichung Veterans General Hospital, 14 patients (15 hips) received femoral head bone-grafting by modified Harris method as a part of their total hip replacement for acetabular bony deficiencies. They were followed up for an average of 31.7 months (range from 7 to 66 months). The clinical results were classified as excellent (58.3%) and good (41.7%) by Harris hip scoring system. All the grafts presented as "solid incorporation" with the pelvic wall and only one of the grafts was assessed to be "definite resorption" (volume reduction greater than 50%) by radiologic study. The "biologic viability" of these grafts were proved to be positive by scintigraphy in three-dimensional technique (SPECT). According to our limited experience and primary follow-up studies, we found that good clinical results depend on ideal positioning of the acetabular component in the true acetabulum and femoral head bone-grafting is an ideal procedure for the reconstruction of severe acetabular dysplasia in total hip arthroplasty.