Uptake Kinetics of Arsenic in Upland Rice Cultivar Zhonghan 221 Inoculated with Arbuscular Mycorrhizal Fungi

Arbuscular mycorrhizal fungi (AMF) appear to be highly associated with arsenic (As) uptake in host plants because arsenate (As(V)) and phosphorus (P) share the same transporter, whereby AMF can enhance P uptake. A short-term experiment was conducted for low- (0 to 0.05 mM As) and high-affinity (0 to 2.5 mM As) uptake systems, to investigate the AMF role on As uptake mechanism in plants, which may explain As uptake kinetics in upland rice cultivar: Zhonghan 221. When concentration of As ranged from 0 to 0.05 mM, Funneliformis geosporum (Fg) significantly decreased arsenite (As(III)) and monomethylarsonicacid (MMA) uptake when (p < 0.05) compared to non-mycorrhizal (NM) treatment, since the major route for (As(III)) in rice roots-rice silicon transporter Lsi1 would be influenced by Fg inoculation at high As concentrations. Fg can also reduce As(V) uptake significantly (p < 0.05) under both uptake systems relative to NM treatment, whereas, Funneliformis mosseae (Fm) increased As(V) and MMA uptake in rice roots, with MMA uptake rate generally lower than As(III) and As(V). Using suitable AMF species inoculation with rice, As uptake and accumulation in rice grains can be reduced and the risk to human health, once consumed, can be minimized.

Arsenic uptake in upland rice inoculated with a combination or single arbuscular mycorrhizal fungi

A pot trial was conducted to investigate the role of arbuscular mycorrhizal fungi (AMF) on arsenic (As) uptake of upland rice (Oryza sativa L.) cultivar, Zhonghan 221; where the following 3 species of Glomus geosporum (Gg), G. mosseae (Gm) and G. versiforme (Gv) were applied as single or combined inoculations. In general, Gm significantly enhanced (p<0.05) total As concentration in Zhonghan 221 when compared to the non mycorrhizal (NM) treatment. The treatment inoculated with Gg + Gm increased total phosphorus (P) uptake and decreased total As uptake in the ingestible rice parts (husks and grains). In terms of AMF colonization rates, Gm had significantly higher (p<0.05) average values of 57.3% and 66.6% when grown in As0 and As40 soils, respectively, in comparison to that of Gg and Gv, and finally dropped to 3.63% when grown in As80 soil. There was a significant difference (p<0.05) between single AMF species (Gg or Gv) and AMF mixture treatments (Gg + Gv, Gg + Gm, Gv + Gm and Gg + Gv + Gm) in terms of total As concentrations in rice. No significant correlation between AMF colonization rates and As uptake in grains (r = 0.150, p > 0.01) and total P (r = 0.002, p > 0.01) were observed.

Can arbuscular mycorrhizal fungi improve grain yield, As uptake and tolerance of rice grown under aerobic conditions?

The effects of arbuscular mycorrhizal fungi (AMF) -Glomus intraradices and G. geosporum on arsenic (As) and phosphorus (P) uptake by lowland (Guangyinzhan) and upland rice (Handao 502) were investigated in soil, spiked with and without 60 mg As kg(-1). In As-contaminated soil, Guangyinzhan inoculated with G. intraradices or Handao 502 inoculated with G. geosporum enhanced As tolerance, grain P content, grain yield. However, Guangyinzhan inoculated with G. geosporum or Handao 502 inoculated with G. intraradices decreased grain P content, grain yield and the molar ratio of grain P/As content, and increased the As concentration and the ratio of grain/straw As concentration. These results show that rice/AMF combinations had significant (p < 0.05) effects on grain As concentration, grain yield and grain P uptake. The variation in the transfer and uptake of As and P reflected strong functional diversity in AM (arbuscular mycorrhizal) symbioses.

Benign nodular goitre presenting as acute airway obstruction

BACKGROUND

Although rare in non-endemic areas, benign nodular goitre may cause acute airway obstruction and the clinical management of this condition remains a challenge.

METHODS

From 1996 to 2005, a total of 1115 patients underwent thyroid surgery at our institution and of these, 7 patients were identified to have a benign nodular goitre leading to acute airway obstruction. They were retrospectively reviewed with reference to the aetiology, presentation, perioperative management and postoperative outcome.

RESULTS

All seven patients were elderly women with a history of symptomatic goitre and concomitant medical problems. Five patients required emergency tracheal intubation, whereas two patients underwent urgent tracheostomy. Total thyroidectomy was successfully carried out for all patients and there was no hospital death. Perioperative complications included three patients with pneumonia, two with renal failure and one with perforated duodenal ulcer. Surgically related complications included transient recurrent nerve palsy in one patient and transient hypocalcaemia in four. After a median follow up of 22 months (range, 4-53 months), two patients died of cerebrovascular accident.

CONCLUSION

Prompt airway protection followed by total thyroidectomy within the same hospital admission should be recommended and can be associated with favourable outcome.

Staging systems for papillary thyroid carcinoma: a review and comparison

OBJECTIVE

To find out the most predictive staging system for papillary thyroid carcinoma (PTC) currently available in the literature.

BACKGROUND

Various staging systems or risk group stratifications have been used extensively in the clinical management of patients with PTC, but the most predictive system for cancer-specific survival (CSS) based on distinct histologic types remains unclear.

METHODS

Through a comprehensive MEDLINE search from 1965 to 2005, a total of 17 staging systems were found in the literature and 14 systems were applied to the 589 PTC patients managed at our institution from 1961 to 2001. CSS were calculated by Kaplan-Meier method and were compared by log-rank test. Using Cox proportional hazards analysis, the relative importance of each staging system in determining CSS was calculated by the proportion of variation (PVE).

RESULTS

All 14 staging systems significantly predicted CSS (P < 0.001). The 3 highest ranked staging systems by PVE were the Metastases, Age, Completeness of Resection, Invasion, Size (MACIS) (18.7) followed by the new AJCC/UICC 6th edition tumor, node, metastases (TNM) (17.9), and the European Organization for Research and Treatment of Cancer (EORTC) (16.6).

CONCLUSIONS

All of the currently available staging systems predicted CSS well in patients with PTC regardless of which histologic type from which they were derived. When predictability was measured by PVE, the MACIS system was the most predictive staging system and so should be the staging system of choice for PTC in the future.

Staging systems for follicular thyroid carcinoma: application to 171 consecutive patients treated in a tertiary referral centre

A number of risk-group stratification or staging systems have been found useful at stratifying patients with differentiated thyroid carcinoma into risk groups. Those identified as high risk could be subjected to more aggressive treatment, while those at low risk could be spared of such treatment. However, the best stratification system in patients with follicular thyroid carcinoma (FTC) remains unclear. Through a comprehensive MEDLINE search from 1965 to 2005, a total of 18 different staging systems were identified in the literature and 14 of them were applicable to 171 patients, with FTC managed at our institution from 1961 to 2001. Cancer-specific survivals (CSS) were calculated by Kaplan-Meier method and were compared by log-rank test. Using Cox proportional hazards analysis, the relative importance of each staging system in determining CSS was calculated by the proportion of variation in survival time explained (PVE). CSS were predicted by 13 out of the 14 staging systems significantly (P < 0.001). The three highest ranked staging systems by PVE were the new American Joint Committee on Cancer/Union Internationale Centre le Cancer 6th edition, tumour, node, metastases (TNM; 22.4), followed by the Clinical Class (21.2) and the metastases, age, completeness of resection, invasion, size (MACIS; 20.4). In conclusion, 13 out of the 14 presently available staging systems predicted CSS significantly in FTC. When predictability was measured by PVE, the TNM system was found to have the best predictability and thus, should be the stratification system of choice for FTC in the future.

Restaging of Differentiated Thyroid Carcinoma by the Sixth Edition AJCC/UICC TNM Staging System: Stage Migration and Predictability

BACKGROUND

The AJCC/UICC TNM staging system (TNM) is a widely accepted system for differentiated thyroid carcinoma (DTC). The objective of the present study was to evaluate the potential changes in cancer-specific survival (CSS) after reclassification from fifth to sixth edition TNM.

METHODS

A total of 760 DTC patients managed at our institution from 1961 to 2001 were retrospectively restaged from the fifth to sixth edition TNM. CSS were calculated using Kaplan-Meier method and were compared by the log-rank test. The relative ability of each edition in predicting CSS was calculated by the proportion of variance explained (PVE).

RESULTS

Upon reclassification, the proportion of T1 and T3 tumors increased from 14.2 to 33.4% and 10.0 to 33.7%; T2 and T4 decreased from 44.2 to 25.0% and 31.6 to 7.9%, respectively; N0 remained unchanged at 66.0%; N1a decreased from 25.7 to 4.7%; N1b increased from 8.4 to 29.3%; stages I and IV tumors increased from 55.7 to 60.3% and 3.4 to 17.6%, respectively; stages II and III tumors decreased from 20.5 to 13.9% and 20.4 to 8.2%, respectively. The sixth edition had a higher PVE value than the fifth edition. Significant differences in CSS were observed between stage III (fifth edition) and stage III (sixth edition) and between stage IV (fifth edition) and stage IVA (sixth edition).

CONCLUSIONS

The sixth edition TNM caused marked changes in the pT, pN and allocation of patients into different tumor stages. It appeared to have superior predictability over the fifth edition.

A prospective evaluation of preoperative localization by technetium-99m sestamibi scintigraphy and ultrasonography in primary hyperparathyroidism

BACKGROUND

Ultrasonography (USG) and technetium-99m sestamibi (MIBI) scintigraphy are commonly used imaging modalities in the era of minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (pHPT). However, their relative importance and actual contribution to MIP have not been prospectively assessed.

METHODS

A total of 100 consecutive pHPT patients planning for MIP were recruited. Both USG and MIBI findings were correlated with intraoperative findings and postoperative outcome. Clinicopathologic factors were examined for potential association with a correct localizing result.

RESULTS

Thirty men and 70 women (age range 13 to 93 years [median 55.5]) were included in the study. The final pathology included 98 patients with solitary adenoma and 2 patients with multiglandular disease. The sensitivities, accuracies, and positive predicted values for USG and MIBI alone were 57% vs 89%, 56% vs 85%, and 97% vs 94%, respectively. Correctly localized adenomas were significantly heavier than incorrectly localized ones.

CONCLUSIONS

MIBI is preferred over USG in pHPT patients planning for MIP. Weight of adenoma appeared to be the only clinicopathologic factor determining localization accuracy.

The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at risk

BACKGROUND

The role of intraoperative neuromonitoring of recurrent laryngeal nerve (RLN) during thyroidectomy has not been well established. The present study evaluates whether RLN injury can be reduced by the application of this technique during thyroidectomy in a single center.

METHODS

Of 1000 RLNs that were at risk of injury in 639 consecutive patients who underwent thyroidectomy, the outcome of 501 RLNs with the use of neuromonitoring was compared with that of 499 nerves that were operated by routine identification only. The incidences of RLN paralysis were compared between the 2 groups and the assigned risk subgroups.

RESULTS

Postoperative palsy was identified in 47 RLNs (4.7%), with complete recovery in 37 of 44 RLNs (84%) without documented injury. The overall incidence of postoperative RLN paralysis was significantly higher during thyroidectomy for malignancy (P = .025) and secondary thyroidectomy (P = .017). There was no significant difference in postoperative, transient, and permanent paralysis rates between the neuromonitoring and control groups. In subgroup analysis, the postoperative RLN palsy rate was higher during reoperative thyroidectomy (19% vs 4.6%; P = .019) in the control group but not in the neuromonitoring group (7.8% vs 3.8%; P > .05).

CONCLUSION

Neuromonitoring of the RLN during thyroid surgery could not be demonstrated to reduce RLN injury significantly, compared with the adoption of routine RLN identification. However, its application can be considered for selected high-risk thyroidectomies.

Prognostic Factors in Papillary and Follicular Thyroid Carcinoma: Their Implications for Cancer Staging

BACKGROUND

Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are two distinct histological types of thyroid carcinoma but have often been studied and staged as a collective group, known as differentiated thyroid carcinoma (DTC). However, this may not be an optimal approach to cancer staging.

METHODS

A total of 760 patients with DTC, comprising 589 (77.5%) with PTC and 171 with (22.5%) FTC, being managed at our institution from 1961 to 2001 were retrospectively reviewed. Their clinicopathological features, treatment modalities received, and postoperative outcome were analyzed. Both univariate and multivariate analyses were performed to identify prognostic factors related to cancer-specific survival (CSS) for PTC and FTC.

RESULTS

There were statistically significant differences between PTC and FTC in terms of age >/=50 years at diagnosis (P = .040), tumor size (P < .001), lymph node metastases (P < .001), distant metastases (P < .001), extrathyroidal extension (P < .001), multifocality (P = .002), capsular invasion (P < .001), extent of thyroid resection (P < .001), radioiodine ablation (P < .001), and external-beam irradiation (P = .003). Although PTC and FTC had similar 10-year and 15-year CSS (P = .846), each possessed its own set of independent prognostic factors for CSS. Age at diagnosis and completeness of resection were independent prognostic factors in both PTC and FTC.

CONCLUSIONS

There were marked differences in clinicopathologic features, treatment, and prognostic factors between the two histologic types of DTC. Different staging systems should be evaluated and validated for PTC and FTC individually in the future.

Multidisciplinary Approach to the Management of Breast Cancer in Hong Kong

INTRODUCTION

Treatment of breast cancer has become more complex and sophisticated in recent years, and a multidisciplinary team approach to management is now recommended worldwide. The present study reviews the applicability of the multidisciplinary approach to the management of patients with breast cancer in a private hospital.

METHODS

Between September 2003 and April 2005, a total of 579 consecutive patients undergoing breast cancer surgery were studied. Patients receiving neoadjuvant chemotherapy or who had metastatic disease at presentation were excluded. Demographic and operative details, pathology, and recommended adjuvant therapy were discussed in the weekly multidisciplinary breast conference involving breast surgeons, pathologists, and radiation and medical oncologists.

RESULTS

The mean age was 48.6 years. A self-discovered breast lump (80%) was the most common presentation, whereas screening mammography accounted for only 12.2%. The accuracy of preoperative mammography, ultrasonography, fine-needle aspiration cytology, and core biopsy were 66.5%, 80.7%, 89.4%, and 98.9%, respectively. Mastectomy was performed in 49.3% of patients, of whom 22.0% underwent immediate reconstruction. Eighty-five percent of patients underwent concomitant axillary surgery, comprising either sentinel node biopsy (49.9%), sentinel node biopsy followed by axillary dissection (38.7%), or axillary dissection alone (11.4%). The mean size of invasive tumors was 2.3 cm, and lymph node metastases were detected in 40% of patients; stage 0, I, II, and III disease was present in 14.2%, 34%, 44.5%, and 7.2% of patients, respectively. Adjuvant hormonal therapy, chemotherapy and radiotherapy were recommended in 62.4%, 51.2%, and 64.9% of patients, respectively.

CONCLUSIONS

Breast cancer in Hong Kong most often presents as a breast lump discovered by self-examination. The role of screening mammogram has to be reevaluated. Multidisciplinary teamwork is essential for optimizing decision-making about adjuvant treatment interventions in such patients.

Classical and Follicular Variant of Papillary Thyroid Carcinoma: A Comparative Study on Clinicopathologic Features and Long-term Outcome

INTRODUCTION

The follicular variant of papillary thyroid carcinoma (FVPTC) is the most common histologic subtype of papillary thyroid carcinoma (PTC). However, it is still controversial whether FVPTC should behave differently from classical PTC (CPTC). The present study aimed at evaluating any potential difference in clinicopathologic features and long-term outcome of FVPTC as compared with CPTC.

PATIENTS AND METHODS

Of 568 patients with PTC managed from 1973 to 2004, 308 were shown to have CPTC (54.2%) and 67 (11.8%) FVPTC after histologic review. The mean (+/- SD) follow-up period was 11.3 (+/- 8.9) years. The two groups were compared in terms of clinicopathological features, treatment received, and outcome regarding recurrence and disease-specific survival.

RESULTS

There was no difference in age and gender ratio between the CPTC and FVPTC patients. Both groups had similar tumor characteristics in terms of tumor size, presence of multifocality, capsular invasion, lymphovascular permeation, and perineural infiltration. However, FVPTC patients had significantly fewer histologically confirmed cervical lymph node metastases (P = 0.027) and extrathyroidal involvement (P = 0.005). The proportion of bilateral resection, adjuvant radioactive iodine, and lymph node dissection did not differ significantly between the two groups. The FVPTC patients had a more favorable tumor risk by DeGroot classification (P = 0.003) and MACIS (Metastasis, Age, Completeness of excision, Invasiveness, and Size) score (P = 0.026). The 10- and 15-year actuarial disease-specific survivals did not differ significantly between FVPTC and CPTC patients (96.2% versus 90.7% and 96.2% versus 89.1%, respectively).

CONCLUSIONS

Although patients with FVPTC had more favorable clinicopathologic features and a better tumor risk group profile, their long-term outcome was similar to that of CPTC patients.

Pitfalls of Intraoperative Neuromonitoring for Predicting Postoperative Recurrent Laryngeal Nerve Function during Thyroidectomy

INTRODUCTION

Intraoperative neuromonitoring has been widely adopted to facilitate the identification and preservation of recurrent laryngeal nerve (RLN) function during thyroid surgery. The present prospective study validated the ability of this technique to predict postoperative RLN outcomes in a single endocrine surgical unit.

METHODS

Neuromonitoring was performed using Neurosign 100 with laryngeal surface electrodes in 171 patients with 271 nerves at risk during thyroidectomy. Vocal cord function was routinely documented perioperatively. Patients were also stratified to low risk (primary surgery for benign disease) and high risk (malignancy and recurrent disease) for subgroup analysis.

RESULTS

Unilateral vocal cord palsy occurred in 15 patients (5.5%) postoperatively. The incidence of postoperative nerve palsy in the low risk and high risk groups was 4.4% and 7.8%, respectively. All but two patients had recovery of function within a median period of 4 months after the operation. The rates of transient and permanent RLN palsy based on nerves at risk were 4.8% (n = 13) and 0.7% (n = 2), respectively. There were 241 true-negative (positive signal and no cord palsy), 15 false-positive (negative signal but no cord palsy), 8 true-positive (negative signal and cord palsy), and 7 false-negative (positive signal but cord palsy) results, as correlated with the postoperative assessment. The sensitivity, specificity, and positive and negative predictive values were 53%, 94%, 35%, and 97%, respectively. For the high risk group, the sensitivity and positive predictive value increased to 86% and 60%, respectively.

CONCLUSIONS

There are pitfalls associated with the use of intraoperative neuromonitoring during thyroid surgery. Routine application is not recommended except for selected high risk patients.

Papillary Microcarcinoma: Is There Any Difference between Clinically Overt and Occult Tumors?

INTRODUCTION

Papillary microcarcinoma (PMC) is a subtype of papillary thyroid carcinoma (PTC) associated with excellent prognosis. However, clinical and biologic behaviors of PMC may vary considerably between tumors that are clinically overt and those that are occult.

MATERIALS AND METHODS

From 1964 to 2003, 185 of 628 patients with PTC were identified as having PMC, based on tumor size < or = 1 cm. There were 110 overt and 75 occult PMCs detected based on clinical presentation. The clinicopathologic features, treatment, and long-term outcome of PMCs were evaluated and compared between the two groups.

RESULTS

There were 37 men and 148 women with a median age of 45 years (range: 11-84 years). The median tumor size was 6.2 mm. Thirty-eight (21%) patients presented with cervical nodal metastases. Three (1.6%) had distant metastases and 5 (2.7%) underwent incomplete resection. Bilateral procedures were performed for 129 patients (70%) and 53 (29%) received postoperative I131 treatment. During a mean follow-up of 8.2 years, 4 patients died of the disease and 13 developed recurrence. Clinically overt PMCs were significantly larger, were more likely to be multifocal, and more likely to lead to bilateral thyroidectomy. Extrathyroidal or lymphovascular invasion, nodal metastases, I131 ablation, high-risk tumors, and postoperative recurrence occurred in overt PMC only. Patients with nodal metastases had a decreased survival and an increase in locoregional recurrence.

CONCLUSIONS

Despite a relatively good prognosis in PMC, a distinction should be made between clinically overt and occult PMCs in which clinically overt PMC should be managed according to tumor risk profile and clinical presentation.

Increased expression of vascular endothelial growth factor C in papillary thyroid carcinoma correlates with cervical lymph node metastases

PURPOSE

Despite recent studies showing that vascular endothelial growth factor C (VEGF-C) mRNA is up-regulated in papillary thyroid carcinoma (PTC), the role of VEGF-C in lymph node metastasis is still unclear. The aim of this study is to investigate the expression pattern of VEGF-C immunoreactive protein in PTC and its relationship with cervical lymph node metastasis.

EXPERIMENTAL DESIGN

Tissue samples were obtained from 39 specimens of PTC (20 with and 19 without lymph node metastasis) as well as 20 benign thyroid nodules. Overexpression of the VEGF-C protein was evaluated by immunoblotting with specific anti-VEGF-C antibody in paired tumor and nontumor tissues from PTC. The data were compared with patients' clinicopathologic features and lymph node metastasis. Immunohistochemical staining was done on selected paraffin sections to determine cellular localization of VEGF-C and to assess flt-4 (or VEGFR-3)-positive vessel density in PTC lesions.

RESULTS

Overexpression of VEGF-C was detected in 69% of the PTC and in 5% of the benign thyroid specimens. When comparing between the metastatic and nonmetastatic groups of PTC, a higher expression level of VEGF-C was detected in both the tumor (P = 0.004) and adjacent nontumor tissues (P = 0.011). Positive immunostaining for VEGF-C was confirmed in PTC tumor tissues and metastatic lymph nodes, which correlated with flt-4-positive vessel density in tumor and peritumor tissues. The increased expression of VEGF-C protein in PTC is associated with lymph node metastasis (P = 0.004) and lymphovascular permeation (P = 0.001) but is independent of other clinicopatholgic variables.

CONCLUSIONS

The VEGF-C immunoreactive protein is overexpressed in PTC lesions, which correlates with lymph node metastases. VEGF-C expression may play a role in lymphangiogenesis of PTC and further study is necessary to evaluate the clinical application of VEGF-C as a molecular marker for tumor metastases to cervical lymph nodes.

Laparoscopic enucleation of a nonfunctioning neuroendocrine tumor at the head of the pancreas

OBJECTIVE

Laparoscopy is a safe, feasible technique for benign pancreatic pathologies and has been increasingly reported for neuroendocrine tumors located at the body and tail of the pancreas. We report a case of successful enucleation of a nonfunctioning neuroendocrine tumor located at the head of the pancreas, in a patient with multiple endocrine neoplasia type I.

METHODS

A 5-cm nonfunctioning neuroendocrine tumor at the pancreatic head was identified by computerized tomography scan. Laparoscopic ultrasound did not reveal additional tumors on any other part of the pancreas.

RESULTS

Enucleation was successfully performed for this solitary tumor because of its favorable position. Histology revealed an islet cell tumor. No postoperative complications occurred and recovery was rapid.

CONCLUSION

Laparoscopic enucleation of neuroendocrine tumor at the pancreatic head is safe and feasible for select patients.

Follicular thyroid carcinoma: the role of histology and staging systems in predicting survival

OBJECTIVE

To evaluate the risk factors including tumor histomorphology for survival specific to follicular thyroid carcinoma (FTC) and to apply commonly employed staging systems in predicting survival for patients with FTC.

SUMMARY BACKGROUND DATA

FTC is usually analyzed collectively with papillary thyroid carcinoma (PTC) in risk group analysis. Risk factors and risk group analysis are important in the management of patients with FTC, although current published therapeutic guidelines call for total thyroidectomy followed by radioactive iodine (I) ablation for all FTC patients.

METHODS

Over a 40-year period, 156 patients surgically treated for FTC with an average follow-up of 14.4 years were retrospectively studied after histologic reclassification according to the type and degree of invasiveness of the tumor. Potential risk factors for survival were calculated using multivariate analysis, and the prognostic accuracy of AMES risk group stratification, UICC/AJCC pTNM staging, Degroot classification, and MACIS scoring schemes in predicting survival was compared.

RESULTS

Seventeen (11%) patients had distant metastases at presentation, and bilateral thyroid resection was performed for 131 (84%) patients. Seventeen (11%) patients died of recurrent or metastatic disease. The overall and cancer-specific survival (CSS) rates at 10 years were 79% and 88%, respectively. None of the patients with minimally invasive (n = 49) or angioinvasive (n = 23) carcinomas died compared with 17 of 84 patients with widely invasive carcinomas (P = 0.0007). Using the Cox proportional hazards model, old age, the presence of distant metastases, and incomplete tumor excision were independent prognostic factors for survival. For patients who underwent curative treatment, old age and widely invasive carcinoma were risk factors for poor survival. All staging systems studied accurately predicted CSS, and the pTNM UICC/AJCC staging system yielded the best prognostic information.

CONCLUSIONS

Commonly adopted staging systems can be applied specifically to patients with FTC. The distinction of FTC in minimally invasive and widely invasive carcinoma based on the extent of invasiveness rather than vascular invasion is important in identifying low-risk FTC patients for a more conservative management.

Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves' disease

BACKGROUND

Total thyroidectomy is increasingly being adopted for patients requiring surgical treatment for Graves' disease based on a comparable surgical risk and the lack of recurrence, as well as the questionable ability of subtotal thyroidectomy to maintain euthyroidism. The purpose of the present paper was to evaluate its safety and efficiency.

METHODS

Total thyroidectomy was adopted as part of the routine surgical treatment for Graves' disease from 2000. Patients who underwent subtotal thyroidectomy (STT) from 1995 to 1999 (n = 119) were compared with those who underwent total thyroidectomy (TT) from 2000 to 2003 (n = 98) with respect to immediate postoperative morbidity and long-term outcome.

RESULTS

Fourteen (11.8%) and 22 patients (22.4%) required calcium supplement on discharge in the STT and TT groups, respectively (P < 0.05). One (0.8%) and three patients (3.1%) developed permanent hypocalcaemia, respectively. Transient recurrent laryngeal nerve palsy occurred in 9.2% (n = 11) and 5.1% (n = 5) of patients or 5.0% and 2.6% of nerves at risk after STT and TT, respectively. None of the patients had permanent nerve palsy. The estimated blood loss was less and hospital stay shorter after TT. During a mean follow up of 64 months, 86 patients (72.3%) in the STT group required thyroxine replacement and seven patients (5.9%) developed relapse.

CONCLUSION

Subtotal thyroidectomy was associated with relapse as well as hypothyroidism in a significant proportion of patients during long-term follow up. Total thyroidectomy can be performed as safely as STT and should be recommended as the procedure of choice for patients requiring surgical treatment for Graves' disease.

Recurrent laryngeal nerve palsy in well-differentiated thyroid carcinoma: clinicopathologic features and outcome study

Involvement of the recurrent laryngeal nerve (RLN) by well-differentiated thyroid carcinoma may not invariably lead to unilateral cord palsy, although the presence of RLN palsy is associated with locally advanced disease. The present study evaluates the clinicopathologic features and outcomes of patients surgically treated for well-differentiated thyroid carcinoma with documented nonfunctioning RLN at presentation. From 1970 to 2002, 20 of 709 patients undergoing surgical treatment for well-differentiated thyroid carcinoma were found to have ipsilateral unilateral cord palsy by routine preoperative laryngoscopy. There were 5 men and 15 women with a median age of 70 years. Nine patients (45%) did not have a clinically palpable thyroid mass, and hoarseness was the primary presenting symptom. All patients had histologically confirmed pT4 papillary thyroid carcinoma with a median size of 4 cm. Cervical nodal and pulmonary metastases were detected in 14 (70%) and 2 (10%) patients, respectively. The ipsilateral recurrent nerve was transected in all patients because of gross tumor involvement, and 19 patients underwent total or completion total thyroidectomy. Resection was incomplete in 15 patients, including 2 who underwent a debulking procedure and required reoperation for local control. Postoperative radioactive iodine ablation and external-beam irradiation were administered to 18 and 13 patients, respectively. Over a median follow-up of 4.5 years, 10 patients survived without evidence of recurrence, 5 died of disease recurrence, and 5 died of unrelated causes. The 5-year and 10-year cause-specific mortality was 17% and 42%, respectively. Patients developing distant metastasis at presentation or during follow-up had a significantly increased cause-specific mortality (p = 0.002). Preoperative RLN palsy can be the first symptom in patients with locally advanced papillary thyroid carcinoma. Despite the adoption of a relatively conservative surgical treatment, long-term survival can be achieved in selected patients.

Applicability of tissue aspirate for quick parathyroid hormone assay to confirm parathyroid tissue identity during parathyroidectomy for primary hyperparathyroidism

HYPOTHESIS

Intraoperative quick parathyroid hormone (PTH) assay for tissue aspirate facilitates the confirmation of parathyroid tissue identity and allows a more selective use of frozen section examination during parathyroidectomy for primary hyperparathyroidism.

DESIGN

A retrospective review of a prospective protocol of the applicability and accuracy of quick PTH assay for tissue aspirate as a biochemical frozen section tool.

SETTING

A university hospital department of surgery.

PATIENTS

Quick PTH assay for aspirate obtained from suspected parathyroid gland excised during parathyroidectomy for primary hyperparathyroidism.

MAIN OUTCOME MEASURES

The accuracy of this biochemical identification of parathyroid tissue identity was correlated with histological examination and outcome.

RESULTS

Quick PTH assay was performed for aspirate from at least 1 excised parathyroid gland in 122 (98%) of 125 patients while 13 patients (10%) had PTH aspirate for nonparathyroid tissues including thyroid (n = 10), thymic (n = 2) and lymphatic (n = 1) tissues. Frozen section examination was performed for 15 patients (12%), including the 3 patients who did not undergo tissue aspirate for quick PTH assay. All except 3 patients had an aspirate assay value of greater than 1500 pg/mL (range, 625 to >1500 pg/mL) for parathyroid tissue while the value of PTH aspirate for nonparathyroid tissue ranged from 27 to 229 pg/mL (median, 72 pg/mL) in 13 patients. The median size of abnormal parathyroid gland was 70 to 15,000 mg (median, 775 mg).

CONCLUSIONS

With the availability of quick PTH assay, tissue aspirate for PTH assay can be adopted as an alternative to traditional frozen section examination to confirm parathyroid gland identity. Frozen section examination can be employed more selectively.

Optimizing the treatment of AMES high-risk papillary thyroid carcinoma

A minority of patients with papillary thyroid carcinoma (PTC) is at high-risk of developing recurrent disease and death. Risk group stratification as defined by age, metastases to distant site, extrathyroidal invasion, and tumor size (AMES) criteria is frequently employed to identify high-risk patients for aggressive surgical and adjuvant treatments. The present study aimed at evaluating risk factors and the impact of treatment on cause-specific mortality (CSM) in this group of high-risk patients. From 1961 to 2000,150 of 499 patients surgically treated for PTC were considered as high-risk by AMES criteria. At 10-years CSM was significantly higher in high-risk patients (28%) than in low-risk patients (2%) (p < 0.0001). The clinicopathologic features, treatment, and outcome of AMES high-risk patients were retrospectively studied and risk factors for CSM were analyzed. There were 58 men and 92 women with a median age of 62 years (range: 18-87 years). Bilateral thyroidectomy was performed for 143 (95%) patients and concomitant neck dissection was performed for 82 patients (55%). Thirty-six patients (24%) underwent incomplete tumor excision with residual disease. Radioactive iodine (I131) ablation and external-beam irradiation were administered to 102 (68%) and 46 patients (31%), respectively. Over a median follow-up of 7.6 years, the overall mortality was 23% and 44%, whereas the CSM was 14% and 28% at 5 and 10 years, respectively. Using the Cox proportional hazard model, distant metastasis at presentation, incomplete tumor excision, and no postoperative I131 treatment were independent prognostic factors of poor survival. Patients who underwent an incomplete excision showed improved survival after I131 ablation (p = 0.0008), external-beam irradiation (p = 0.02), or both forms of treatment (p = 0.04). Within this high-risk AMES group, International Union Against Cancer (UICC) pTNM staging and MACIS (Metastasis, Age, Completeness, Invasion, Size) scoring correlated significantly with CSM. AMES high-risk PTC patients should undergo total thyroidectomy aiming at complete tumor resection followed by I131 ablation. External-beam irradiation should be added for patients with residual disease after an incomplete excision.

Resection of phaeochromocytoma extending into the right atrium in a patient with multiple endocrine neoplasia type 2A

We report the first case of successful surgical resection of a malignant phaeochromocytoma with tumour extension into vena cava and right atrium in a patient with multiple endocrine neoplasia type 2A. A 21-year-old woman with genetic confirmation of multiple endocrine neoplasia type 2A syndrome was diagnosed with a very rare case of malignant phaeochromocytoma with tumour thrombus extension into vena cava and right atrium causing Budd-Chiari syndrome. It posed a challenge to the surgeons with regard to complete tumour resection and vascular control. Reviewing the limited literature, surgical resection by means of cardiopulmonary bypass with hypothermic circulatory arrest has been reported with success in phaeochromocytoma with advance vascular involvement. Adopting this approach, adrenalectomy with complete thrombus excision by inferior vena cava exploration and right atriotomy were performed successfully by a multidisciplinary team.

Multiple endocrine neoplasia type 2B in a Chinese patient

Multiple endocrine neoplasia type 2B syndrome is rarely reported in Chinese patients. A 25-year-old Chinese male presented with full-blown clinical features of this syndrome, including bilateral phaeochromocytomas, medullary thyroid carcinoma, and characteristic phenotypic features. One-stage surgical treatment was performed and subsequent genetic analysis confirmed a point mutation at codon 918 in exon 16 of the RET proto-oncogene. The mutation was arising de novo as there was no corresponding mutation found in both his parents or younger sister. Data published to date suggest there is no difference in the genetic and pathophysiologic basis, nor clinical characteristics of multiple endocrine neoplasia type 2B in Chinese patients. As the disease can be lethal, early diagnosis by prompt recognition of the characteristic phenotypic features followed by surgical treatment should improve the outcome. Family screening is essential to identify at-risk family members for prophylactic treatment.

Surgical treatment for primary hyperparathyroidism in Hong Kong: changes in clinical pattern over 3 decades

HYPOTHESIS

With the introduction of the blood chemistry multichannel autoanalyzer, primary hyperparathyroidism (HPT) is increasingly diagnosed. The clinical pattern of primary HPT has undergone a significant evolution in Western countries. A similar change can be documented in a geographic region where this condition is considered to be relatively uncommon.

DESIGN

Unselected case series.

SETTING

A tertiary referral endocrine surgical unit.

PATIENTS

All patients with primary HPT surgically treated over the past 30 years.

MAIN OUTCOME MEASURES

The prevalence of patients per 100,000 hospital admissions, clinical presentation, biochemistry study results, pathologic status, and main outcome were compared over three 10-year spans according to the introduction of the multichannel autoanalyzer in 1982: 1973-1982 (n = 20), 1983-1992 (n = 31), and 1993-2002 (n = 190).

RESULTS

A 7-fold increase in the prevalence of patients with primary HPT who were surgically treated per 100,000 hospital admissions was observed over the past 10 years. The clinical presentation of patients with primary HPT had evolved progressively with a higher proportion of older patients (P<.001) being asymptomatic. On presentation, the condition had decreased in severity with lower serum calcium (P =.04), parathyroid hormone (P<.001), and alkaline phosphatase levels (P<.001) as well as a smaller adenoma size (P<.001). There was no significant change in the underlying pathologic condition and surgical success.

CONCLUSION

Similar to the West but in contrast to that observed in other Asian countries, an increase in the prevalence of patients surgically treated for primary HPT is documented and a change in disease presentation as well as its severity is observed in our population group.

Minimally invasive endoscopic-assisted parathyroidectomy for primary hyperparathyroidism

BACKGROUND

Minimally invasive surgery for primary hyperparathyroidism (pHPT) depends on both an accurate preoperative localization and the availability of intraoperative parathyroid hormone monitoring.

METHODS

Patients with sporadic pHPT and one unequivocally enlarged parathyroid gland on preoperative imaging underwent endoscopic-assisted parathyroidectomy. Intraoperative rapid parathyroid hormone (quick PTH) monitoring was performed, and surgical success was confirmed when there was a >50% decrease in quick PTH level 10 min after excision as compared with the baseline level at induction. The surgical outcome and the use of preoperative localization, together with the role played by quick PTH assay in enhancing the operative success, were evaluated.

RESULTS

From 1999 to 2002, 66 of 107 patients (62%) were selected for this approach. The accuracy of 99mTc-Sestamibi scintigraphy and ultrasonography was 97% and 70%, respectively. Conversion was required in four cases due to technical problems, and four additional patients failed to show a significant decline in quick PTH levels postexcision. Two patients underwent cervical exploration without the finding of any additional pathology, and another two patients had a delayed drop in quick PTH that was confirmed 30 min postexcision. All patients had a solitary adenoma and were cured of hypercalcemia during a median follow-up of 9 months.

CONCLUSIONS

Minimally invasive endoscopic-assisted parathyroidectomy can be performed expeditiously in a select group of patients based on 99mTc-Sestamibi scintigraphy. The use of quick PTH assay can ensure surgical success, but careful interpretation of the results is mandatory.

Duplex ultrasonography after total hip or knee arthroplasty

We prospectively studied all patients admitted for total hip (THR) or knee (TKR) arthroplasty from July 2000 to February 2001. No pharmacological anticoagulation was given. All patients received a standardized postoperative rehabilitation regimen. Forty-six patients with known risk factors for deep vein thrombosis (DVT) were excluded. Eighty patients were studied (22 THR, 58 TKR; 55 women, 25 men). Mean age was 68 (30-90) years. Duplex ultrasonography on both lower limbs was performed on days 5-7 postoperatively. Location and extent of any thrombus were documented. In patients with distal DVT, a follow-up scan was done on days 10-14. If proximal propagation was observed, patients received full anticoagulation. If no propagation was detected, the distal thrombus was considered stable and clinical observation was continued. In the THR group, 1/22 and in the TKR group 9/58 were found to have distal DVT. All were asymptomatic. On follow-up scanning, none showed proximal propagation. All patients were followed up for at least 18 months, and none showed postthrombotic symptoms. Isolated distal DVT in "low-risk" Chinese patients after THR or TKR is not uncommon. Clinically they are usually "silent." If routine perioperative pharmacologic antithrombotic prophylaxis is not practiced, monitoring with duplex ultrasonography may need to be considered.

Deep venous thrombosis after total hip or knee arthroplasty in a "low-risk" Chinese population

Scarcely any information has been published on deep vein thrombosis (DVT) in Chinese patients after total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, generally, no prophylaxis is given to patients who do not have conventional high-risk factors because they are believed to be at "low risk." We performed a prospective study on 80 such "low risk" patients undergoing THA or TKA (58 TKA and 22 THA) without prophylaxis and performed duplex ultrasonography on both lower limbs 6 to 8 days after surgery. A total of 22 patients (27.5%) showed ultrasonographic evidence of DVT. Eighteen (31%) TKAs and 4 (18.1%) THAs were complicated by DVT. Three patients showed bilateral involvement, all of whom underwent TKA. Two patients had symptomatic pulmonary embolism. The sensitivity and positive predictive value of the clinical examination was 27.2% and 31.6%, respectively. This study showed that patients who are labeled "low risk" for DVT actually had a significant risk and suggests that the current practice of providing prophylaxis to only patients deemed at "high risk" should be revised.

Defatting of skin flaps using arthroscopic instruments--an effective alternative

Defatting is often required when skin flaps are transferred to the hand. We present three patients with skin flaps which were defatted using an arthroscopic shaver and a standard suction device. There were no complications and all three patients were satisfied with their outcomes. This method provided an effective treatment for our patients and did not require the purchase of specialised equipment.

From open to laparoscopic adrenalectomy: a review of 16-year experience

OBJECTIVE

To review the experience with adrenal surgery which was associated with significant morbidity and notable mortality in the past, although laparoscopic approach is beginning to be accepted as the procedure of choice.

METHODS

The indications and results of adrenalectomy in 104 patients (36 men, 68 women) over the past 16 years were reviewed. Any potential improvement of surgical results over time was analyzed.

RESULTS

Ninety-three patients (89%) had functional problems while malignancy was present in 11 patients (11%). Anterior approach was employed in 27 patients, posterior in 56, lateral in 10, and laparoscopic in 11. One patient required conversion from laparoscopic to anterior approach. No operative mortality was seen, but the morbidity occurred in 16.7%. Complication rate decreased significantly in this study period (1981-1990 versus 1991-1996, 22% versus 5%; P = 0.02). Laparoscopic adrenalectomy was successfully performed for 59% of the patients requiring adrenalectomy recently, compared to 68% of posterior adrenalectomy in the past.

CONCLUSIONS

Adrenal surgery is a safe procedure, associated with acceptable morbidity, which has decreased over time. Laparoscopic adrenalectomy is becoming the preferred approach for the majority of patients requiring adrenalectomy.

Isolation of Deinococcus species from commercial oyster extract

Deinococci with radiation resistance greater than that of Deinococcus radiophilus (ATCC 27603) were isolated from three commercial oyster extracts stored at 4, 20, and 30 degreesC. During storage the number of other bacteria declined and deinococci became the predominant group in the microflora, particularly at 20 degreesC, although at 30 degreesC the number of deinococci as well rapidly declined. The results suggest that the natural habitat of deinococci is an aerobic environment containing a slightly elevated saline content, soluble protein, and low sugar levels.

Clock-face drawing, reading and setting tests in the screening of dementia in Chinese elderly adults

Comprehensive neuropsychological batteries focus on the subtle cognitive deficits in dementia, but a brief screening instrument is also of immense practical value. As the clock-drawing test encompasses a number of cognitive domains frequently disturbed by the dementing process, it is considered to be a suitable screening instrument for the disorder. We documented the usefulness of a new scoring method of the clock-drawing test for screening of dementia in the elderly Chinese in Hong Kong. Fifty-three demented individuals and 53 healthy elderly controls were assessed. At a cutoff score of 3/4, the sensitivity and specificity of the clock-drawing test in screening of dementia was 83% and 79%. With a composite test of clock reading and clock setting, the positive predictive value of the clock face test was 98%. This new scoring method of clock-drawing proved to be a valid measure for screening of dementia. It is applicable in non-English speaking populations and should be a useful adjunct for quick screening assessment of dementia.

The modified Fuld Verbal Fluency Test: a validation study in Hong Kong

Recent studies in the West have found that verbal fluency tests are useful in the detection of dementia. In this study, the Fuld Verbal Fluency Test (FVFT) was modified and tested for its usefulness as a screening instrument for differentiating demented from normal elderly Chinese in Hong Kong. Fifty-three normal and 56 demented subjects were administered the FVFT, the Cantonese version of the Mini-Mental State Examination (CMMSE), and the Chinese version of the Hamilton Depression Rating Scale. In addition to bearing significant correlation with the CMMSE, the verbal fluency scores for all semantic categories (animals, fruits, vegetables) were found to produce significant differentiation between the normal and demented groups. However, test-retest reliability for the individual verbal fluency scores was shown to be unsatisfactory, and a composite measure was recommended for use in future screening on the grounds of its enhanced reliability.

Employee stress levels and the intention to participate in a worksite smoking cessation program

This study examines the nature and extent of the relationship between stress levels and intentions to participate in a worksite smoking cessation program among male current smokers (n = 220) employed in an automobile manufacturing plant. A plantwide survey was conducted which measured job stress, nonjob stress, smoking behavior, and intent to participate. The results of polychotomous logistic regressions suggest that among the current smokers in this plant, job and nonjob stress were positively associated with workers' intentions to participate in a worksite smoking cessation program. Thus, contrary to the popular notion that stress diminishes the motivation to quit, employees under high levels of stress may be most receptive to educational interventions intended to persuade smokers to commit to quitting.

Screening for dementia: a preliminary study on the validity of the Chinese version of the Blessed-Roth Dementia Scale

Blessed-Roth Dementia Scale has been one of the most widely used rating scales in dementia. Previous studies indicated that this behavioral assessment scale is a useful tool for differentiating elderly subjects with no or minimal intellectual decline from those with cognitive deterioration. In the present study, the authors examined the validity of the Chinese version of the Blessed-Roth Dementia Scale (CDS) in Hong Kong. A total of 106 Chinese subjects were recruited from a social center, an old-age home, and psychogeriatric outpatient clinics. At a cutoff score of 3 of 4, the CDS achieved a sensitivity of 90.5% and specificity of 98.1% in differentiating demented from healthy control subjects. In the Chinese population studied, the scale was readily acceptable and considered to be an useful adjunct in screening of dementia.

Aqueous humor in glaucomatous eyes contains an increased level of TGF-beta 2

By using the highly sensitive and specific technique of enzyme-linked immunosorbent assay, we investigated the presence and amount of transforming growth factor-beta 2 (TGF-beta 2) in samples of aqueous humor obtained from 15 patients who had a clinically established diagnosis of advanced primary open-angle glaucoma (POAG), as well as from ten age-matched normal human subjects undergoing cataract surgery. The total amount of TGF-beta 2 in the samples of normal aqueous humor ranged from 0.41 to 2.24 ng ml-1 (mean +/- S.D.: 1.48 +/- 0.68 ng ml-1) of which 4.88 to 37.05% (11.99 +/- 9.95%) was intrinsically active. Compared with normal subjects, the aqueous humor from POAG patients had a statistically significantly greater amount of total TGF-beta 2 (2.70 +/- 0.76 ng ml-1, P < 0.01), as well as a higher level of intrinsically active TGF-beta 2 (0.45 +/- 0.28 ng ml-1, P < 0.05) which corresponded to 1.09 to 60.84% (18.33 +/- 15.50%) of the total amount. No linear correlation was found between the age of the subjects and the protein concentration of the aqueous humor from either normal or glaucomatous eyes, nor between the age of the patient and the total amount of TGF-beta 2. The negligible amount of TGF-beta 2 present in serum argues against its influx into the aqueous humor after breakdown of the blood-aqueous barrier that is known to occur in glaucomatous eyes; rather, our present findings support the concept of the intraocular derivation of this cytokine.(ABSTRACT TRUNCATED AT 250 WORDS)

Trabecular cells express the TGF-beta 2 gene and secrete the cytokine

We investigated whether trabecular cells contain TGF-beta 2 mRNA and whether they synthesize this cytokine. By using a primer pair for TGF-beta 2 and the highly specific and sensitive techniques of reverse transcriptase-polymerase chain reaction, a single amplified sequence was obtained from cultured trabecular cells and tissue samples of trabecular meshwork, corneal epithelium, iris and ciliary body ex vivo from fresh porcine eyes. Regression analysis with standard DNA size markers indicated that the products were of the anticipated size of 310 base pairs. Southern hybridization further confirmed that all of the products were specific for TGF-beta 2. Enzyme-linked immunosorbent assay (ELISA) with a specific antibody against TGF-beta 2 revealed that this cytokine was secreted by cultured trabecular cells in the conditioned medium. The TGF-beta 2 produced by trabecular cells was in a latent form, and no intrinsically active protein was detected. The results suggest that TGF-beta 2 has an autocrine and/or paracrine action in the trabecular meshwork system, and that trabecular cells could contribute to the presence of TGF-beta 2 in their microenvironment as well as in aqueous humor. It is hypothesized that abnormal changes in the production of TGF-beta s by trabecular cells and/or in the activation of these growth modulators contribute to the excess accumulation of extracellular matrix components in the aqueous outflow system as observed in aging and glaucomatous eyes.

Interaction of berberine with human platelet alpha 2 adrenoceptors

Berberine, an alkaloid, has been found to have a myriad of pharmacological effects including hypotensive, antisecretory, sedative, and antimicrobial effects, some of which are similar to those of clonidine, an alpha 2 adrenoceptor partial agonist. The interaction of berberine with human platelet alpha 2 adrenoceptor was investigated in this study. Berberine was found to inhibit competitively the specific binding of [3H]-yohimbine. The displacement curve was parallel to those of clonidine, epinephrine, norepinephrine, with the rank order of potency (IC50) being clonidine (0.4 microM) greater than epinephrine (7.5 microM) greater than norepinephrine (14.5 microM) = berberine (16.6 microM). Increasing concentrations of berberine from 0.1 microM to 10 microM inhibited [3H]-yohimbine binding, shifting the saturation binding curve to the right without decreasing the maximum binding capacity. In platelet cyclic AMP accumulation experiments, berberine at concentrations of 0.1 microM to 0.1 mM inhibited the cAMP accumulation induced by 10 microM prostaglandin E1 in a dose dependent manner, acting as an alpha 2 adrenoceptor agonist. In the presence of L-epinephrine, berberine blocked the inhibitory effect of L-epinephrine behaving as an alpha 2 adrenoceptor antagonist. These properties are similar to those of clonidine on human platelets, suggesting that berberine is a partial agonist of platelet alpha 2 adrenoceptors. These findings may provide potential mechanisms for the hypotensive, antisecretory, and sedative effects of berberine.

Clinical observation on the uterotonic effect of I-mu Ts'ao (Leonurus artemisia)

Normal fertile women given an oral dose of I-mu Ts'ao decoction (30 g. dry weight equivalent) showed an increase in intra-uterine pressure in 41.3% of 121 cases. The increase ranged from 150% to over 300% of spontaneous activity before dosing. A slightly higher success rate was observed with 2 successive doses or with improved experimental skill in later cases. Ergonovine (0.2 mg i.m.) scored a success rate of 61%. Therefore, I-mu Ts'ao decoction appeared to have a relative potency of 91% compared with ergonovine when the highest success rate (55.5%) of the former is considered. Blank control with water yield a positive response rate of 2.7%. There are no observable side-effects apart from diuresis.

Mucinous cystadenoma, serous cystadenoma and benign cystic teratoma of the ovary: clinico-pathologic differences observed in a Malaysian hospital

A study of 207 benign ovarian tumors seen at the University Hospital, Kuala Lumpur between 1968 and 1975 was made to evaluate the clinical features that might be useful in the preoperative differentiation of mucinous cystadenoma, serous cystadenoma, and cystic teratoma of the ovary. This study indicated that the pertinent information included the mean age of the patient, the marital and menstrual status, and the estimated tumor size. The racial background was an additional factor in serous cystadenoma. Features like parity, the location of the tumor, and ABO blood group pattern were of no value in the preoperative differentiation.

Amniography in the early diagnosis of hydatidiform mole

In 16 patients with suspected hydatidiform mole the diagnosis was readily confirmed by amniography. A characteristic honeycomb pattern was seen in all cases. Opacification of the pelvic and ovarian veins was observed in 11 patients, four of whom also showed an excretory urogram. No complications occurred. We conclude that amniography is a simple, safe and reliable method of establishing the diagnosis in clinically suspected cases of hydatidiform mole. Amniography should be considered: (1) as a primary procedure where facilities for ultrasonic investigations and for chorionic gonadotrophin (HCG) determinations are not available, or (2) when ultrasonic examination and the HCG levels are equivocal.