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Background Breast cancer is rare in men and managed by extrapolating from breast cancer in women. The clinicopathological features of male breast cancer, however, differ from those of female breast cancer. Because clinical trials are rare, the synthesis of real-world data is one method of integrating sufficient evidence on the optimal treatment for this patient population. Methods PubMed, Embase, and Cochrane Library databases were searched. Clinical studies were included if they evaluated the treatments of interest in male breast cancer; these evaluations included breast-conserving surgery (BCS) versus mastectomy, postmastectomy radiation therapy versus no radiation, the accuracy of sentinel lymph node biopsy (SLNB), and a comparison of various endocrine therapies. Results Forty studies were retrieved. The pooled estimate of overall survival (OS) revealed no difference between BCS and mastectomy groups. Postmastectomy radiation to the chest wall significantly increased OS relative to no postmastectomy radiation (hazard ratio (HR) 0.67, 95 per cent confidence interval 0.54 to 0.84). The pooled estimates of identification and false-negative rates of SLNB were 97.4 and 7.4 per cent respectively. Tamoxifen treatment was associated with significantly increased OS compared with no tamoxifen intake (HR 0.62, 0.41 to 0.95). Conclusion Identification and false-negative rates for SLNB were comparable to those in female breast cancer. Breast-conserving surgery can be effective and safe; postmastectomy radiation to the chest wall and 5-year tamoxifen treatment improves survival.

Background Patients with obstructive sleep apnea (OSA) have elevated nasopharyngeal resistances due to increased turbulent airflow. The study aims to investigate the effect of oropharyngeal surgery on nasal resistance in patients with various severity levels of OSA. Methodology Patients with greater or equal to 5 events hourly on the apnea-hypopnea index (AHI) were enrolled. Patients with retropalatal obstruction underwent uvulopalatopharyngoplasty, while patients with concurrent retrolingual obstruction under- went uvulopalatopharyngoplasty (UPPP) plus tongue base suspension. Before surgery and after surgery, subjective outcomes were assessed using a visual analog scale (VAS), and objective outcomes were assessed using overnight polysomnography and rhinomanometry. The limitation of the study was that UPPP instead of expansion sphincter pharyngoplasty was performed in this study. Results Sixty-two patients were enrolled, while 30 patients were diagnosed as mild OSA (group Mild) and 32 patients were mo- derate-severe OSA (group MS). The preoperative VAS of nasal obstruction in recumbency during sleep was significantly reduced after surgery in group MS. However, no significant differences between preoperative and postoperative VAS were found in group Mild. The postoperative anterior and posterior total nasal resistances (TNR) in sitting and supine positions were not significantly different from those before surgery in group. In contrast, the postoperative posterior TNR in supine position was 0.292±0.301(Pa/ cm3/s), compared with 0.425±0.343(Pa/cm3/s) preoperatively. Conclusions Oropharyngeal surgery improves nasal obstruction during sleep and lowers the supine TNR measured in poste- rior rhinomanometry in patients with moderate-severe OSA. Oropharyngeal surgery is a possible treatment for postural nasal obstruction in patients with moderate-severe OSA.

Chromosomal aberration analysis in peripheral blood lymphocytes was performed to evaluate late cytogenetic effects of long-term low dose-rate gamma-irradiation exposure among students and residents exposed in radiocontaminated buildings.Blood samples were taken from 1913 subjects (age 17.8+/-13.6, mean+/-SD) 5-8 years after their relocation from radioactive environments as well as from 176 non-exposed subjects (age 29.6+/-11.9) from the local community. Their lymphocytes were cultured for 48 h and metaphase spreads were prepared. A total of 208 900 metaphases were analysed for different types of chromosomal aberrations.Relatively higher frequencies of translocations (2.1 x 10(-3)), rings (0.6 x 10(-3)) and dicentrics (0.6 x 10(-3)) were noted in the exposed population as compared with the nonexposed reference populations. Moreover, 356 (78.6%) of the 453 inversions were found on 14q11.2q32 in the exposed population. Among 392 well-demonstrated translocations, 167 (42.6%) and 175 (44.6%) occurred in chromosomes 7 and 14, respectively, while 139 (35.5%) occurred as t(7;14). In particular, the aberrations t(7;14)(p13;q11.2), t(7;14)(p15;q11.2) and t(7;14)(q36;q11.2) were the most prevalent, occurring with frequencies of 19 (13.7%), 20 (14.4%) and 27 (19.4%), respectively. In these, 3205 breakpoints were documented, with chromosomes 7, 9 and 14 shown to carry significantly higher frequencies of breakpoints than expected (chi(2)-test, p0.0001). A further six hotspots were identified on 7p15 (57, 1.8%), 7q36 (42, 1.3%), 9q12 (244, 7.6%), 9q13 (86, 2.7%), 14q11.2 (509, 15.9%) and 14q32 (387, 12.1%) in the exposed population.In comparison with the unexposed population, we observed increased frequencies of various chromosomal aberrations in this human population with previous exposure to prolonged low dose-rate gamma-radiation. Moreover, several hotspot breakpoints and inversions and translocations were observed on chromosomes 7 and 14.

Inflammatory pseudotumors of the lung are uncommon and etiologically diverse lesions that often present as solitary masses in the lung. It may be difficult to distinguish these lesions from more commonly encountered lung neoplasms. Inflammatory pseudotumors can also occur in other organs, but the lung is most commonly involved. We describe a 63-year-old male coal miner with a 40-year history of dust exposure, who had a large right middle lobe mass on chest roentgenograms, with slow growth over the 7 years prior to admission. Repeated transthoracic echo-guided biopsies of the mass were indicative of an inflammatory and reactive process. The radiographic, histologic, and clinical findings indicated a diagnosis of inflammatory pseudotumor. The patient refused surgical intervention and was regularly followed at our outpatient clinic. Follow-up chest roentgenograms for 1 year revealed that the tumor size was stable. This case suggested that inflammatory pseudotumor, although uncommon, should be included in the differential diagnosis in a patient with pneumoconiosis and a solitary mass in the lung.

Continuous hyperthermic peritoneal perfusion (CHPP) with anticancer agents in warm saline was performed in 10 patients with cancer of the digestive tract and peritoneal carcinomatosis after resection of primary and metastatic lesions or both. Eight patients had colorectal cancer and one patient had recurring gastric cancer. CHPP was performed using saline containing mitomycin-C and 5-flurouracil at 42 degrees C to 43 degrees C for 60 minutes. One patient with pancreatic cancer received CHPP twice. After CHPP, the preoperative ascites of three patients disappeared. Four patients died of malignancy within 1 year of CHPP and one patient died of respiratory failure 5 months post-CHPP. The remaining five patients survived for more than 1 year after CHPP. There were no significant immediate postoperative complications, except for transient changes in liver function, white blood cell count and serum albumin level. While CHPP treatment appears to be a safe method of treatment for peritoneal carcinomatosis, its long term benefits need further investigation.

A 54-year-old male suddenly developed cramping abdominal pain followed by diarrhea. A segmental narrowing with multiple mucosal ulcers of the colon near the splenic flexure was noted on both barium enema and fiberoptic colonoscopy. Cramping abdominal pain and diarrhea persisted, associated with a body weight loss of 13 kg. Four months later, angiography revealed an isolated, complete occlusion of the left colic artery near the point of branching from the inferior mesentery artery. The artery was biopsied and the severely strictured colon was removed. The artery showed an eccentric organized hematoma between the outer media and the adventitia. The lumen was occluded by organized thrombi. The pathologic findings were those of an organized dissecting hematoma (aneurysm), probably caused by segmental mediolytic arteriopathy.

Two cases of subcutaneous sparganosis were discovered at the Taipei Institute of Pathology in early spring of 1992. They had been resected under the impression of lipomas of the chest and abdomen. Both lesions contained characteristic plerocercoid larva (sparganum) of Spirometra sp., presumably Spirometra mansoni. Characteristic tissue reactions included necrosis, granulomatous reaction, and lymphoplasma cell infiltrates with focal collections of eosinophils. Since the worm can be readily dislodged from the tissues, an accurate diagnosis may not be possible in every instance. Thus, the prevalence of the disease may have been underestimated. Consuming raw flesh of infected second intermediate hosts or paratenic hosts and drinking unboiled water contaminated by infected Cyclops seems to favor the endemic occurrence of the disease in Taiwan.

Pancreatoblastoma is an extremely rare pancreatic tumor in childhood, comprising 0.5% of pancreatic non-endocrine tumors. It mostly affects children of under 8 years old without special sexual predilection. Abdominal mass is the dominant clinical feature and abdominal X-ray, sonography, UGI series, CT scan are of assistance in establishing diagnosis. The presence of acinar cells with zymogen granules, squamous metaplasia and endocrine components makes the diagnosis. We report a case of 4-year-old girl, who suffered from abdominal pain for two months. Abdominal mass was found at our OPD and abdominal sonography, UGI series, CT scan all indicated a parapancreatic tumor. AFP was 4700 ng/ml. Laparotomy confirmed a pancreatic tumor and only partial excision was performed due to tumor invasion and adhesion to major vessels. Diagnosis of pancreatoblastoma was made by pathohistology, cytochemical special stains and electronic microscopic examination of the tumor. Neither chemotherapy nor radiotherapy was performed due to family refusal. Then patient followed up at NTUH OPD regularly. Unfortunately patient expired because of the regrowth of residual tumor eight months later.

A 36-year-old multiparous woman presented with the chief complaint of mass and fullness over the lower abdomen for the previous 3 months. Abdominal ultrasound revealed a uniloculated, thin-walled cyst attached to the peritoneal surface of the right lower abdomen. The cyst was surgically excised and confirmed to be cystic mesothelioma of the peritoneum by histopathologic and immunohistochemical studies. Benign cystic mesothelioma is an extremely rare intraperitoneal tumor. Although its etiology remains unclear, one distinctive clinicopathologic feature is a symptomatic abdominal mass in young females. The presence of a thin-walled cyst attached to the peritoneum on ultrasound should alert physicians to the possibility of this disease. The treatment of choice is complete resection and reexcision may be required due to a preponderance for local recurrence. Regular postoperative ultrasound follow-up is recommended to check for possible recurrence.

Epithelial and capillary basal laminae (BL) of alveoli are significantly thicker in diabetics than they are in age-matched control subjects. The degree of thickening does not correlate significantly with patient age or with known duration of diabetes. The thickness of both types of BL in the lungs correlates significantly with thickness of BL in renal tubules and muscle capillaries. However, in muscle capillaries and in renal tubules, the BL deposits are 5 to 10 times greater than they are in the lungs. The effects of BL changes on pulmonary function remain to be explored.

A patient with angioimmunoblastic lymphadenopathy with dysproteinemia was followed over a three year period from diagnosis to death. He presented with arthralgias, uveitis and respiratory insufficiency and developed hyperuricemic renal failure upon institution of treatment. Aggressive combination chemotherapy was required to reverse progressive thrombocytopenia and pulmonary involvement. A complete remission was achieved twice. There was a striking temporal relationship between the administration of antibiotics or allopurinol and exacerbations of the disease. Hypocomplementemia and transient evidence of vasculitis suggested the presence of immunecomplexes. Serial lymph node biopsies showed the progression of this disorder from a pleomorphic immunoblastic proliferation to a lymphocyte-depleted, fibrotic process, in parallel with a decline from hyper- to hypogammaglobulinemia. This case illustrates the broad clinical spectrum of angioimmunoblastic lymphadenopathy with dysproteinemia and suggests that aggressive treatment is necessary in selected patients.

The human glomerular basal lamina (HGBL) is composed of collagenous and noncollagenous glycoproteins. We assessed the role played by each costituent in platelet-basal-lamina interaction by selective cleavage and removal of each component by clostridial collagenase or by pepsin. When noncollagenous proteins are removed from HGBL, human platelets exhibit littel reactivity toward the residual collagen framework of the isolated basal lamina. With the noncollagen matrix of basal lamina, after removal of the bulk of the collagen, platelet adhesion and spreading proceed normally in the presence of divalent cations, similar to what occurs on intact basal lamina. No platelet degranulation or aggregation is observed. The results indicate that the basal lamina collagen, even in its native packing arrangement, lacks affinity for platelet adhesion and is incapable of triggering platelet release reactions. Platelet adhesion and spreading on the basal lamina appears to depend primarily on the presence of the noncollagen components and to require divalent cations. The data suggest the presence on platelets of receptors for basal lamina distinct from those for interstitial collagens. These receptors activate a unique modulation of platelet behavior, ie, adhesion and spreading without degranulation. A difference in biologic function of the basal lamina and interstitial collagens is apparent in these experiments.

An unusual glomerulonephritis characterized by diffuse mesangial cell necrosis and lysis of mesangial areas was observed in a male infant who had a combined immune deficiency and systemic echovirus type 6 infection. The occurrence of glomerular disease in a patient with combined immune deficiency indicates that the glomerular injury can be inflicted without mediation of immune mechanisms, presumably by direct cytopathic effect of echovirus 6.

Immunohistochemical studies of two glycolipid tissue antigens were carried out to ascertain their distribution in normal as well as cancerous gastric mucosa. A trihexose ceramide (Kiyo antigen), a precursor of ABH blood group substances, is present in epithelial cell membrane and mucin of 90% (45 of 50) of noncancerous gastric mucosa. The distribution is similar to blood group substance; 10.7% (3 of 28) of gastric carcinoma that arose in Kiyo-positive gastric mucosa exhibited complete loss of the antigen, while carcinomas from Kiyo-negative gastric mucosa remained Kiyo negative. A fucopentaose ceramide (Lex), however, is absent from noncancerous gastric mucosa but present in varying quantity in 92.9% (52 of 56) of gastric carcinomas. The emergence of Lex as a tumor cell marker in the great majority of gastric carcinomas indicates its potential application in the diagnosis and assessment of tumor loads in gastric carcinoma patients.

To assess the value of tumor marker determinations in diagnosing lung cancer and monitoring the response to therapy in lung cancer patients, we tested the serum concentration of TuMark-reactive protein and carcinoembryonic antigen (CEA) in 78 patients with lung cancer and 81 patients with non-malignant diseases. The sensitivity of TuMark in detecting the presence of lung cancer was 63.8%, compared to 37.2% for CEA (p less than 0.05). The specificity was 91.3% for TuMark and 97.5% for CEA. The combination of TuMark and CEA increased the sensitivity to 74.3%. The sensitivity of TuMark for non-small cell carcinoma was significantly higher than that for small cell carcinoma (67.6% vs 30.0%) (p less than 0.05). The incidence of positive TuMark reactivity did not correlate with the stages of lung cancer. Since the incidence of positive CEA reactivity was lower in the limited stage than in the extensive stage of lung cancer (20.0% vs 43.1%), the sensitivity of TuMark with regard to the detection of early stage lung cancer appeared far superior to CEA (65.0% vs 20.0%, p less than 0.05). Serial monitoring of TuMark levels in 32 patients with all types of lung cancer showed that 84% correlated with their clinical courses. Six patients with stage I or II disease received complete surgical resection of tumors. All showed a decline of the TuMark level to normal levels in 17 to 48 days (average of 32 days). These results suggested that the TuMark test may be a useful new marker for diagnosing lung cancer and monitoring response to therapy, especially for non-small cell lung cancer.

Studies of human diabetic glomerulosclerosis with a newly devleoped guanidine method have revealed that, like renal tubules, thickening of the glomerular capillary basal lamina is due exclusively to inordinate accumulation of the epithelial basal lamina. There is no excessive deposition of the endothelial basal lamina. Thus, the diabetic nephropathy is characterized by a diffuse thickening of the epithelial basal lamina involving the entire nephron unit, a feature distinct from peripheral diabetic microangiopathy, where the endothelial basal lamina plays a predominant role. The nodular and diffuse mesangial sclerosis is composed of increased mesangial basal lamina, there is no evidence indicating collapsed capillary epithelial basal lamina within Kimmelstiel-Wilson nodules. Hitherto undescribed alterations in the juxtamesangial epithelial basal lamina suggesting new glomerular capillary tuft formation are also presented.

Survival and turnover of platelets, fibrinogen, and plasminogen were measured in association with hyperbaric exposure in man. In addition, kinetic and vascular studies were carried out in a hyperbaric swine model to assess the role of vascular injury and thrombosis in the pathogenesis of dysbaric osteonecrosis. In man, significant increases in platelet and fibrinogen consumption were directly associated with dive depth and with repetitive exposure at lesser depths. The increased destruction of platelets and fibrinogen was not accompanied by reduced blood levels because of compensatory shifts in production rats and distribution between circulating and storage compartments. Platelet consumption was substantially greater than fibrinogen destruction with respect to both severity and duration. Platelet function inhibitors decreased platelet consumption. Increased fibrinogen consumption was sometimes associated with reduced plasminogen survival, but levels of fibrinogen/fibrin degradation products were never measurably altered from normal values. The relationships among platelet and fibrinogen consumption, vascular changes, and dysbaric osteonecrosis were studied in hyperbaric swine. Consumption of hemostatic factors was most severe with rapid, uncontrolled decompression, low oxygen concentrations, and deeper or repetitive dives. Platelet consumption induced by hyperbaric exposure resolved spontaneously with time, suggesting a repair process after the simulated diving conditions were discontinued. Interruption of increased platelet and fibrinogen consumption in the swine model required either moderation of the dive profile or a combination of drugs that inhibit platelet function (dipyridamole or sudoxicam) together with an anticoagulant (warfarin or heparin). Repeated hyperbaric exposure under conditions that uniformly produced femoral osteonecrosis and consumption of platelets and fibrinogen was associated with detectable endothelial injury and arterial intimal lesion formation. Since the diving characteristics of increasing depth and inadequate decompression were associated with both the most severe consumption and the highest frequency of intravascular bubble formation, we postulate that intravascular bubbles, formed during hyperbaria, produce osteonecrosis, perhaps through the following sequence: (1) bubble-related endothelial cell damage; (2) platelet thrombus formation with secondary fibrin deposition; (3) microvascular occlusion; and (4) platelet-dependent arterial narrowing through intimal lesion formation. The role of antithrombotic therapy in the prevention of dysbaric osteonecrosis remains to be determined.

Carcinosarcomas are rare tumors of the upper aerodigestive tract, consisting of both carcinomatous and sarcomatous tissue. The larynx and oral cavity are most frequently involved. There has been much controversy regarding the histological nature and clinical course of these tumors. We report a case of carcinosarcoma of the floor of mouth in a 76 year old man who presented with a large pedunculated sublingual mass. There was no evidence of regional or systemic metastatic disease. After local excision, he was followed for one year without evidence of recurrence or metastasis. A review of the literature is presented, with an attempt to clarify clinically relevant aspects of nomenclature, pathogenesis, and clinical course.