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Early detection of disseminated tumor cells in the peripheral blood of patients with early stage gastric cancer could help to improve the outcome after tumor resection. The aim of this study is to evaluate the prognostic significance of tumor-related mRNA for the detection of circulating tumor cells in gastric cancer patients by a reverse-transcriptase polymerase chain reaction (RT-PCR) method. We simultaneously analyzed human telomerase reverse transcriptase (hTERT), cytokeratin-19 (CK-19), cytokeratin-20 (CK-20) and carcinoembryonic antigen (CEA) mRNA (messenger RNA) expression in the peripheral blood of 42 gastric cancer patients and 30 healthy individuals. Additionally, analyses were carried out for the correlation of these four molecular markers with patients’ clinicopathologic features, as well as the occurrence of postoperative recurrence/metastasis. Among 42 gastric cancer patients, the prevalence of mRNA for hTERT, CK-19, CK-20, and CEA was 61.9% (26/42), 69% (29/42), 61.9% (26/42), and 78.6% (33/42), respectively. All 30 healthy individuals were negative for hTERT and CEA mRNA, while two were positive for either CK-19 mRNA or CK-20 mRNA. Positive CEA mRNA was significantly correlated with tumor size (p= 0.008), vessel invasion (p= 0.001), depth of tumor invasion (p= 0.007), lymph node metastasis (p< 0.001), and TNM stage (p< 0.001). In addition, the multivariate logistic regression demonstrated that CEA mRNA expression was an independent and significant predictor for postoperative recurrence/metastasis (p= 0.032). Our findings suggest that CEA mRNA may be a more reliable marker than hTERT, CK-19 and CK-20 for the detection of circulating cancer cells in gastric cancer patients' peripheral blood. Patients with positive CEA mRNA expression in peripheral blood have a significantly higher risk of postoperative recurrence/metastasis.

This study aimed to assess the role of endoscopic ultrasonography (EUS) in the surgical management of isolated gastric varices (IGV), and to report the authors' experience in the treatment of IGV with modified devascularization surgery.In this study, 26 cirrhotic patients with IGV were treated with devascularization surgery for variceal hemorrhage. Preoperatively, percutaneous transhepatic portography (PTP) and EUS were used to determine the mode of therapy for IGV. Fundectomy was performed for 14 patients with fundic IGV, whereas 12 patients with cardiac IGV underwent proximal gastrectomy.A significantly higher proportion of patients with cardiac varices showed grade 3 IGV on preoperative EUS than those who had fundic varices (p0.05). No major complications were observed during or after the operation, and only one patient died of prolonged shock and massive transfusion. Postoperatively, gastric varices had been eradicated completely in 25 of 26 patients, as determined by EUS study. During a mean follow-up period of 50 months, two patients had recurrent varices without bleeding, as demonstrated by EUS. The overall 5-year survival rate for the fundic IGV group was 67.9%, whereas that for the cardiac IGV group was 64.3% (p0.05).This study showed that devascularization surgery is highly effective for the prevention of recurrent bleeding from IGV and provides an alternative treatment method. Preoperatively, EUS is very helpful in detailed devascularization of patients with specific IGV, and may be used also for postoperative follow-up evaluation.

Primary abscess of the omentum is an infrequent disease entity. We report a case of 60-year-old male patient who suffered from left lower quadrant abdominal pain with localized abdominal wall tenderness, nausea and high-grade fever for the previous few days. Computerized tomography scan revealed a heterogeneous lesion that adhered to the abdominal wall. A pre-operative diagnosis of colonic diverticulitis complicated with intra-abdominal abscess was made and a laparotomy was done. At surgical exploration, an indurate mass consisting of abscess within the omentum was identified. The surgical procedure consisted of resection of the omental abscess with abdominal wall debridement, and subsequent antimicrobial therapy was administered. Postoperatively, the patient recovered uneventfully. Clinicians who treated such patients should be aware of this problem because of the difficulty of preoperative diagnosis.

p53 gene mutation and p53 protein accumulation is the most common event in human cancers. The present study was conducted to investigate the occurrence of p53 mutations in patients with gastric carcinoma in Taiwan.Tumor samples from 36 patients with primary gastric carcinoma undergoing radical gastrectomy were evaluated. The mutational status of the p53 (exons 5 to 8) was screened by polymerase chain reaction/single strand conformation polymorphism (PCR-SSCP) analysis followed by direct sequencing. These results were compared with p53 protein expression as assessed by immunohistochemical staining.Of all 36 gastric carcinomas, mutations of the p53 gene were found in 7 cases (19.4%). These results from direct sequencing indicated that mutations consisted of five missence mutations, one silent mutation and one mutation within the splice donor site of intron 5. Mutations were found at codon 145 in exon 5 (1 case), intron 5 (1 case), codon 248 in exon 7 (1 case), codon 251 in exon 7 (2 cases), codon 285 in exon 8 (1 case) and codon 287 in exon 8 (1 case). The mutation hot spot at codon 251 in gastric cancer has not been observed previously. Over-expression of p53 oncoprotein was observed in 10 patients (27.8%) immunohistochemically.p53 gene mutation might contribute to the pathogenesis of human gastric carcinoma. However, the suggestion awaits further investigation for confirmation.

Mondor's disease, superficial thrombophebitis of the breast, is an uncommon self-limiting condition. Surgical procedures and trauma were the common known causes. The objective of this study was to evaluate the incidence of Mondor's disease in different breast operations in lower risk of breast cancer area over a 6-year period and to identify its causes, clinical features, related surgical factors and associated breast cancer. Eighty-four cases of Mondor's disease were obtained from 9657 new patients in the breast clinic of Kaohsiung Medical University Hospital between January 1991 and December 1996. The incidence per year was close (0.84%-0.96%) although the number has been increasing each year. In 23 cases, no definite cause was diagnosed, whereas in 61 cases, the disorder was secondary because the pathogenesis could be discerned. The identified causes included forty-three cases caused by breast surgery, two cases associated with breast cancer and sixteen cases with other benign causes. Although the incidence did not differ significantly between breast surgery (0.95%) and non-surgical causes (0.79%), the highest incidence, 1.52%, occurred when excision through circumareolar incision and tunnel procedure for cosmesis (25 cases in 1634 excisions) were used, and the lowest 0.69% when excisions through direct incision (14 cases in 2004 excisions) were performed. (P0.05) The other incidence rates were 1.56% in breast conserving surgery which is higher than 0.37% following mastectomy. The incidence of the disease was higher (4.28%) when the distance of the breast lesion was more than 3 cm from the areolar edge, compared to 1.20% for the 2 cm group and 0.32% for the 1 cm group (P0.05) in tunnel procedures. The incidence of Mondor's disease during breast surgery was not significantly different in different breast quardrants. Although Mondor's disease is a benign, self-limiting condition, a high incidence developed in the excision biopsy through circumareolar incision with tunnel procedure when the distance from the breast lesion to the areolar edge was more than 3 cm. To prevent this complication, the tunnel procedure in breast biopsy should be avoided. The incidence of Mondor's disease associated with breast cancer was low (2.4%) in the lower-incidence breast cancer area from this series, but awareness of the condition is recommended.

The Truquant BR radioimmunoassay (RIA) using monoclonal antibody BR 27.29 to recognize a peptide sequence on the MUC-1 gene product for quantification of the CA 27.29 antigen in serum was used in this report to evaluate in 145 patients with breast cancer and compared the other conventional serum markers such as CA15-3 and CEA. The upper limit of normal (25 u/ml) was determined from CA27.29 values 12.4 +/- 4.1 u/ml (mean +/- 3 S.D.) for 112 female subjects apparently free of disease. The CA15-3 levels above 25 u/ml and CEA levels above 5 ng/ml were considered positive values. Thirty-seven cases of 145 patients studied had elevated CA 27.29 levels (sensitivity: 25.5%), 35 of 145 had positive CA15-3 levels (sensitivity 24.1%) and 27 of 145 patients had positive CEA levels (sensitivity: 18.6%) (p0.05). One hundred and ten cases of the breast cancer patients (75.8%) did not have metastatic disease. In this group CA 27.29 sensitivity was 6.4%, while CA15-3 sensitivity was 5.5% and CEA sensitivity was 4.5% (p0.05). Mean values were 10.2 +/- 9.2 u/ml for CA 27.29, 14.1 +/- 5.6 u/ml for CA 15-3 and 1.7 +/- 1.5 ng/ml for CEA. Thirty-five patients (24.2%) had metastatic disease. In this group CA 27.29 sensitivity was 85.7%, CA15-3 sensitivity was 82.8% and CEA sensitivity was 62.8% (p0.05). Mean values for CA27.29 was 152.6 +/- 131.6 u/ml, CA15-3 was 123.1 +/- 107.6 u/ml and 21.8 +/- 36.9 ng/ml of CEA. With regard to the correlation of three tumor markers with clinical stages, patients had significantly higher levels of CA27.29 than CEA, but they were similar to CA 15-3 in metastatic breast cancer. These results suggest CA27.29 to be more sensitive and specific than CEA, but that it is similar to CA15-3 for metastatic breast cancer detection and monitoring.

Breast cancer commonly metastasizes to bones, producing both osteolytic and osteoblastic deposits. Different markers for quantitative determination of bone turnover have been developed to evaluate bone metastases of breast cancer. The urinary deoxypyridinoline (Dpd), a crosslink product of collagen molecules found in bone and excreted in urine during bone degradation, and bone specific alkaline phosphatase (B-ALP), an isoenzyme localized in the membrane of osteoblasts and released in circulation during bone formation, were recently described as a group of markers of bone turnover in metastatic cancer. The urinary Dpd/creatinine (Cre) ratios and the serum B-ALP activity were determined in the samples from 148 patients who suffered from breast cancer (BC patients) with or without bone metastases, and 42 healthy women. For comparison, other biochemical markers, e.g. carcinoembryonic antigen (CEA), CA15-3, tissue polypeptide antigen (TPA), tissue polypeptide specific antigen (TPSA), and total alkaline phosphatase (T-ALP) in these samples were also evaluated. The results showed that there was a significant difference in urinary Dpd/Cre ratio between the control group and the patients with breast cancer (BC group) (mean +/- S.D., 5.69 +/- 1.26 vs. 8.19 +/- 3.95 nM/mM, P0.05). However, there was no significant difference between their B-ALP activities in the two groups. In addition, the BC patients with bone metastases showed elevated urinary Dpd/Cre ratios and B-ALP activities and ratios of (Dpd/Cre)/B-ALP in compare with BC patients without bone metastases (P0.05). Meanwhile, the urinary Dpd/Cre ratios (10.50 +/- 5.04 nmol/mmol) in the advanced stage of BC patients were higher than those in an early stage (7.45 +/- 3.23 nmol/mmol) (P0.05), but their serum B-ALP activities increased only in stage IV (P0.05). The urinary Dpd/Cre ratios also increased progressively according to the degree of bone metastases (P0.05), but their serum B-ALP activities only increased in severe bone metastases (P0.05). The results showed that the increase of a bone osteolytic activity took place earlier than that of a bone osteoblastic activity in the metastatic BC patients. In compare with other conventional markers, the best diagnostic efficiency of biochemical markers, analyzed by step wise discriminate analysis, was provided by CEA followed by Dpd/Cre ratio, CA15-3, TPA, TPSA, B-ALP and T-ALP. We conclude that showed the urinary Dpd/Cre ratio was a useful tumor marker to evaluate breast cancer with bone metastases.

Laparoscopic surgical procedures were performed in 18 patients with end-stage renal disease for the placement of a Tenckhoff peritoneal dialysis catheter. Among them, 6 patients had received previous lower abdominal surgical treatment and 3 patients underwent laparoscopic rescue of dysfunctional Tenckhoff catheters. The operating time was between 40 and 80 minutes (median, 50 minutes). After a median follow-up period of 11 months, the short-term results revealed that no significant morbidity was associated with this procedure, and all catheters except two functioned well postoperatively. One of the catheters was not functional because of the patient's death, and the other one was removed because of persistent peritonitis. Laparoscopic secure placement of continuous ambulatory peritoneal dialysis catheters appears to be a simple, safe, and viable procedure, even in patients with previous lower-abdominal operations. The same technique can be used to rescue dysfunctional catheters that are displaced or obstructed by adhesion and omental wrapping, thus increasing catheter longevity.

Vitamin A or its synthetic analogues are potent in controlling cell differentiation and in preventing epithelial cancer in experimental animals. Although some community-based studies have found that high serum retinol levels in prediagnostic sera were associated with reduced risk for cancer, other reports in humans have not confirmed this finding. This study is to evaluate the preoperative serum vitamin A level in breast cancer patients in Taiwan. The serum specimens were collected from 106 female cases of breast cancer (aged 30 to 70 years), 32 female cases of benign breast disease (aged 29 to 57 years), and 40 healthy females (aged 22 to 52 years). The serum vitamin A levels were measured by colorimetic analysis. The results showed the mean value of the vitamin A level was 140.4 +/- 65.7 micrograms/dl in the breast cancer group comparing to 145.2 +/- 44.2 micrograms/dl in the benign breast disease group, 144.0 +/- 30.0 micrograms/dl in the control group (P0.05). The characteristics of the breast cancer group were analyzed and they revealed that serum vitamin A levels did not bear statistically significant differences in age, duration, steroid receptor, tumor size and menopausal state. (P0.05) In conclusion, the serum vitamin A levels were not decreased in early breast cancer patients. The serum vitamin A levels were significantly decreased in the metastatic breast cancer group, especially in liver metastatic women. (P0.05). Postoperative vitamin A supplement may have potential benefit to metastatic breast cancer patients.

Nuclear accumulation of p53 protein is associated with a poor clinical outcome in breast cancer patients. This study was designed to determine the frequency of p53 protein immunoreactivity in primary breast cancer to correlate the presence of p53 protein with established risk factors including the estrogen receptor and progesterone receptor status, and to evaluate the prognostic significance of p53 protein immunoreactivity regarding patient survival in Taiwan. To assess the p53 protein immunoreactivity, 104 patients with breast cancer were examined using immunohistochemical methods. P53 protein was detected in 40 (38.5%) of these primary breast cancer specimens. Highly significant associations were found between p53 protein expression and negative steroid receptors, histologic grade III. There were no statistically significant references in p53 protein expression with respect to age, tumor size, lymph node status, or clinical stage. Patients with p53 positive tumor showed poorer survival but this did not achieve significance. However, there were more patients with poor survival in the axillary node-positive group (p0.05) than in node-negative group. This suggests that the p53 protein expression is marginal as a prognostic indicator in breast cancer with axillary-node metastasis.

The monoclonal antibodies CA15-3 were developed against the two antigens 115D8 of the human milk fat globule membrane and DF3 of breast cancer. CA15-3 was assayed radioimmunologically and CEA was analysed using the enzyme immunoassay. Normal control was achieved in 32 healthy women, the mean values for CA15-3 were 11.5 +/- 3.0 u/ml, range from 7.9 to 16.9 u/ml. We compared serum levels of CA15-3 and CEA in 121 patients with histologically proved breast carcinoma. CA15-3 levels above 25 u/ml and CEA levels above 5 ng/ml were considered positive values. 31 of 121 patients studied had elevated CA15-3 levels (sensitivity: 25.6%) and 21 of 121 patients had positive CEA levels (sensitivity 17.4%). 92 of the breast cancer patients (76%) did not have metastatic disease. In this group CA15-3 sensitivity was 7.6%, while CEA sensitivity was 6.5%. Mean values were 15.1 +/- 6.6 u/ml for CA15-3 and 1.78 +/- 2.47 ng/ml for CEA. 29 patients (24%) had metastatic disease. In this group, CA15-3 sensitivity was 82.8% and CEA sensitivity was 51.7% (P0.05). Mean values for CA15-3 were 147.5 +/- 175.9 u/ml and 16.9 +/- 24.0 ng/ml of CEA. With regard to the correlation of two tumor markers with clinical course patients had significantly higher levels of CA15-3 than of CEA in metastatic breast cancer. This result suggests CA15-3 to be the more sensitive and more specific of the two for metastatic breast cancer detection and monitoring.

Continuous ambulatory peritoneal dialysis (CAPD) is a well-established treatment modality for end-stage renal disease. Abdominal wall hernia is not uncommon in patients on CAPD. Two factors are responsible for the occurrence of these hernias: anatomically weak sites and increased intraperitoneal pressure by the dialysate. Abdominal wall hernia was reviewed in 44 patients on CAPD from 1987 through 1991. Eight abdominal hernias (5 inguinal, 2 incisional and 1 umbilical) were found during CAPD treatment (18.18%). Surgical treatment was applied in 6 symptomatic hernias (5 inguinal and 1 incisional). After surgery, 5 patients returned to CAPD without recurrence and the remaining one died of strangulated incisional hernia. Our series shows that: (1) a detailed examination of the preexisting hernia and repair prior to CAPD treatment are suggested. (2) symptomatic abdominal wall hernia should be evaluated carefully and treated promptly. (3) awareness of the complication of these hernias can reduce the morbidity and mortality.

In a retrospective study, 103 patients undergoing abdominoperineal resection or total proctocolectomy due to rectal adenocarcinoma or familial polyposis with malignant change in the rectum were included. The methods for treating the pelvic and perineal wounds were divided into four categories: (1) suture of the pelvic peritoneum with open drainage, (2) suture of the pelvic peritoneum and perineum with simple drainage, (3) suture of the pelvic peritoneum and perineum with suction drainage, and (4) suture of the perineum with omental pedicle graft. The parameters analyzed were incidence of perineal wound infection, primary healing of the perineum, extraperineal complications and mean hospital stay. The infective rate of the group 1 was significantly higher than for the other groups. The incidence of primary wound healing for groups 2, 3, 4 was 73%, 78%, 81% respectively compared with group 1 of 20% at one month. There was no significant difference between the various groups regarding extraperineal complications. There was no significant difference in hospital stay among groups 2, 3, 4, but they were significantly shorter than for group 1. Primary closure of the pelvic peritoneum and perineal wound with simple drainage is now adopted by us due to its low infection rate, short hospital stay and easy performance.

Mondor's disease is a rare and relatively little known clinical entity. Clinical features include sudden development of localized pain in the breast, followed by visible and papable, tender, cordlike, branching cutaneous grooves. It involves superficial thrombophlebitis of the thoracoepigastric or lateral thoracic vein occurring mostly in middle-age women. The etiology of Mondor's disease is unknown, and it may be related to trauma, operation, infection, bandaging, or tight clothes. The mammogram of most cases showed no abnormality, but the ultrasonography revealed hyperechoic cordlike pattern in the lesions. The symptomatic treatment is required and surgery will be indicated when it is associated with malignancy or severe painful cord due to pain and traction. It usually resolves over a period of 2 to 8 weeks. We report three cases of Mondor's disease and that we believe to be the first reported cases in Taiwan.

From July 1982 to June 1989, 64 patients with trauma involving a colon and rectum operated on at the Kaohsiung Medical College Hospital were retrospectively reviewed. Their ages ranged from 14 to 90 years (mean 43.6 +/- 17.6 years); 48 were male, 16 female. Thirty-four (53.1%) had penetrating injuries, 30 (46.9%) had blunt injuries. Twenty-six (86.7%) blunt injuries and 7 (20.6%) penetrating injuries involved various associated injuries. There was a significantly greater number of associated organ injury in cases of blunt trauma. The most common organ injured concomitantly was the small intestine. The severity of injury and general condition were quantified for each patient using the intraoperative grading system proposed by Flint et al, and revealed that it was independent of the colorectal site, but related to the mode of trauma. After an assessment of the grade of injury, 42 patients underwent colostomies, 14 primary closures, 2 resections and anastomoses and 6 exteriorized repairs In the primary closure group, there was no mortality but 2 suture leakages which reoperated to colostomies. In three patients (50%) of the exteriorized repair group with fecal leakage developed at the repair site, the exteriorized loops were coverted into colostomies without complication. The most common complications were wound infection and abdominal abscess. The mortality (14.1%) and morbidity (45.3%) were not related to the location of the injured bowel but were influenced by the grade of colorectal trauma, associated organ injury and the mode of trauma.(ABSTRACT TRUNCATED AT 250 WORDS)

In January 1981 at the surgical department of the Kaohsiung Medical College Hospital, we began a longterm clinicopathological study of colorectal adenocarcinoma according to "The General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus" issued by the Japanese Research Society for Cancer of the Colon and Rectum. The aim was to evaluate this type of tumor's staging system as a guide to prognosis, and to determine the effects of several clinicopathological characteristics on survival. The data presented are based on the findings in the first 327 patients whose tumors were resectable. The clinicopathological variables included in this study were: age, sex, duration of symptoms, tumor location, the proportion of the bowel wall circumference involved, numbers of lymph nodes involved, depth of the cancer invasion, gross type, histological type and microscopic stage. The microscopic stage was found to be related strongly to survival. Other variables associated with significantly poorer five-year survival were: age under 40 years, duration of preoperative symptoms shorter than 6 months, a tumor occupying more than two-thirds of the bowel wall circumference, greater number of lymph nodes involved, more poorly differentiated cancer, the cancer invading into adjacent organs and ulceroinfiltrative tumor in univariate analysis. The overall five-year survival rate was 53.4% in this series.

From 1977 to 1988, 556 patients underwent emergency surgery for complicated peptic ulcers. Among them, 409 patients were for treated perforations and 147 for hemorrhages. In the perforated ulcer category, the morbidity rate was 12.5% and mortality rate 6.8%. For bleeding ulcers, the morbidity rate was 27.2% and mortality rate 14.9%. Several risk factors, such as age, interval of time between perforation and surgery, blood loss, associated disease, and shock were found to have created a higher operative risk. A definitive surgery including vagotomy and drainage, vagotomy and antrectomy, partial gastrectomy and highly selective vagotomy could be safely performed with an acceptable mortality for properly selected cases. Follow-up results also indicated better scores in this group of patients. We concluded that a definitive ulcer operation is safe, acceptable and curative for low risk patients with perforated or bleeding ulcers.

The extent of the gastric antrum in duodenal ulcer patients and the relationship between the first antral branch of the vagal nerve and proximal delimitation of antrum were examined using resected gastric specimens of 46 duodenal ulcer patients. It has been demonstrated that: (1) There was a variable extent of measured distance from the pyloric ring to the antrum-corpus boundary (intermediate zone), and it ascended with age along the lesser curvature. (2) The intermediate zone was a transitional change of the fundic and pyloric gland area. The change on the lesser curvature was abrupt, but on the greater curvature it was gradual. It displaced distally on the greater curvature, and was found to be symmetrical on the anterior and posterior walls. (3) The proximal delimitation of the antrum lay on the lesser curvature where the first antral branch of the vagal nerve reached the lesser curvature topographically. (4) At the lesser curvature, the antrum-corpus boundary was found to be located within +/- 2 cm from the first antral branch in 93.5% of the cases. It may be a useful landmark to decide the proximal boundary of gastric antrum while performing antrectomy. (5) The shrinkage factor for specimens after 10% formalin fixation appeared to be between 0.7 and 0.9.