Chien-Chang Kao

Congenital Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis Mimicking Bladder Outlet Obstruction: A Case Report and Review of the Literature

Seminal vesicle cysts combined with genitourinary anomalies are uncommon. We present a 43‐year‐old married man who suffered from difficulty in urination and irritating voiding symptoms for 3 years. The symptoms worsened in the last 6 months. Digital rectal examination revealed a palpable large soft mass behind the prostate. Diagnostic imaging showed a left seminal vesicle cyst with an intravesical protrusion. The ipsilateral kidney and ureter were absent. Transrectal aspiration of the cyst was performed, which improved the clinical genitourinary symptoms. The maximal and mean urinary flow rates increased from 18 to 37 mL/s and from 6 to 16 mL/s, respectively.

CSC-3436 switched tamoxifen-induced autophagy to apoptosis through the inhibition of AMPK/mTOR pathway

BackgroundTriple-negative breast cancer (TNBC) lacks specific therapeutic target and limits to chemotherapy and is essential to develop novel therapeutic regimens. Increasing studies indicated that tamoxifen, a selective estrogen receptor modulators (SERMs), has anti-tumor therapeutic effect in estrogen receptor α (ERα)-negative tumor. Here, we determined whether autophagy was activated by tamoxifen in TNBC cells. Moreover, CSC-3436 displayed strong and selective growth inhibition on cancer cells. Next, we investigated the anti-proliferation effect of combination of CSC-3436 plus tamoxifen on cell death in TNBC cells.ResultsOur study found that tamoxifen induces autophagy in TNBC cells. Endoplasmic reticulum stress and AMPK/mTOR contributed tamoxifen-induced autophagy. Interestingly, in combination treatment with CSC-3436 enhanced the anti-proliferative effect of tamoxifen. We found that CSC-3436 switched tamoxifen-induced autophagy to apoptosis via cleavage of ATG-5. Moreover, AMPK/mTOR pathway may involve in CSC-3436 switched tamoxifen-induced autophagy to apoptosis. The combination of tamoxifen and CSC-3436 produced stronger tumor growth inhibition compared with CSC-3436 or tamoxifen alone treatments in vivo.ConclusionThese data indicated that CSC-3436 combined with tamoxifen may be a potential approach for treatment TNBC.

Open, multi-center, phase IV study to assess the efficacy and tolerability of triptorelin in Taiwanese patients with advanced prostate cancer

Background: To evaluate the efficacy and safety of administering a 3‐month formulation of triptorelin as part of disease management of Taiwanese men with advanced adenocarcinoma of the prostate. Methods: Patients with newly diagnosed, locally advanced, or metastatic adenocarcinoma of the prostate were enrolled in our study, after informed consent was obtained. All patients received bicalutamide 50 mg daily for 28 days, starting 7 days before the first injection of triptorelin. A dosage of 11.25 mg triptorelin was injected on Day 0 (baseline) and repeated on Day 90. Prostate‐specific antigen (PSA) and testosterone concentrations were measured on Days 90 and 180. Results: A total of 41 patients were enrolled, with a median age of 78 (57–92) years, and a baseline median PSA of 122.69 ng/mL. One patient dropped out of the study, one was excluded in the fourth month due to a protocol violation, and one died 4 months after initiation of treatment as a result of disease progression. In total, 40 men were eligible for Day 90 and 38 men for Day 180 analysis. On Day 90, 97.5% of men had reached castration testosterone concentration ≤0.5 ng/mL, and all men had reached this concentration on Day 180. Serum PSA concentration declined to 10.40 ± 23.42 ng/mL on Day 90 (p = 0.0126) and 11.61 ± 23.93 ng/mL on Day 180 (p = 0.0172). The most frequently seen adverse event was gastrointestinal disturbance, including abdominal pain, diarrhea and constipation. Generally, adverse events were mild and patient manageable. Conclusion: Triptorelin 11.25 mg is effective in achieving medical castration and lowering PSA concentrations and can maintain its medicinal effect for at least 90 days in Taiwanese men with advanced prostate cancer. This suggests that it can be an effective treatment for advanced prostatic cancer.

Cost-effective homemade specimen retrieval bag for use in laparoscopic surgery: Experience at a single center

BACKGROUND To offer an easily produced and cost-effective specimen retrieval bag that can be used to reduce the cost of laparoscopic surgery. METHODS From January 2005 to October 2009, 135 patients underwent laparoscopic surgery for adrenalectomy or prostatectomy, during which a homemade specimen retrieval bag was used. The retrieval bag was produced from a large sterile surgical glove, 2-0 nylon thread, and 1-0 RB-1 needle Vicryl thread. A purse-string suture at the opening of the bag was made using the nylon thread, and the bottom of the bag was double-tied using the tail of the Vicryl thread. The bag was introduced into the peritoneal cavity via a 12-mm port, and the specimen was enclosed with the use of two laparoscopic instruments. The bag was then extracted by extending the port incisional wound. RESULTS We used a homemade retrieval bag to extract specimens from 110 patients who underwent robot-assisted laparoscopic radical prostatectomy and 25 patients who underwent laparoscopic adrenalectomy. The procedure was performed safely, and no bags were broken. No complications were observed after the operations such as wound infection, ileus, or intestinal adhesion. In our experience, our homemade endobag can be easily used by surgeons to extract specimens from the abdominal cavity. The total cost of hospitalization was also reduced for the patients. CONCLUSION The homemade specimen retrieval bag is cost-effective and useful for the retrieval of intact specimens. It is also easy to make and safe to use.

Short-Term Result of Renal Transplantation Using Extracorporeal Membrane Oxygenation–Supported Brain-Dead Donors

BACKGROUND Extracorporeal membrane oxygenation (ECMO) is now widely used to maintain hemodynamic stability after traumatic events among medical centers. It remains unclear whether renal transplantation using ECMO-supported donors carries poorer outcomes. METHODS From February 2010 to March 2013, we performed 9 renal transplantations (6 females and 3 males) from 5 ECMO-supported donors. Demographic data and clinical outcomes were retrospectively analyzed through medical chart review. RESULTS The mean follow-up period was 15 ± 9 months (range: 8-37). Eight of the 9 grafts remained functioning within the follow-up period. One (11.1%) graft loss was noted after repeated acute rejection. Acute rejection occurred in 3/9 (33%) of cases. Delayed graft function was also observed in 3/9 (33%) of cases. CONCLUSION Renal transplantation using ECMO-supported brain-dead donors was not associated with an unacceptably high rate of graft loss in this short-term follow-up. It might be an alternative way to expand donor pools.

Abdominal Subcutaneous Metastasis from Sarcomatoid Renal Cell Carcinoma

Subcutaneous metastases originating from genitourinary tract cancers are rare, especially for renal cell carcinomas. The most common sites for such metastases are the lung, liver, brain and bone. Subcutaneous metastases are considered ominous. We report a 78-year-old man who presented with a huge solitary mass over the suprapubic region of the abdominal wall. He had been diagnosed as a renal cell carcinoma with multiple pulmonary metastases. Treatment for the mass consisted of wide excision and continuing systemic interferon therapy. The patient died three months after the surgery, following a rapid local recurrence and general deterioration.

Comparison of Different Treatment Schedules of Mitomycin C Intravesical Instillation in High-Risk Superficial Bladder Cancer Patients

ZIEL:  Diese Studie erfolgte zum Vergleich der Wirksamkeit einer intravesikalen Instillation von Mitomycin C (MMC) zur Prävention eines nicht muskelinvasiven Ta- oder T1-High-Risk-Harnblasenkarzinoms (NMIBC) unter Verwendung verschiedener Schemata. MATERIAL UND METHODEN  Diese retrospektive Kohortenstudie wurde bei 152 Patienten durchgeführt, die zwischen April 2009 und September 2016 mit einer intravesikalen MMC-Injektion behandelt wurden. Der mittlere Nachbeobachtungszeitraum lag bei 32,67 Monaten. Alle Patienten unterzogen sich einer vollständigen transurethralen Resektion des Blasentumors (TURBT), an die sich innerhalb von 24 Stunden eine postoperative Instillation von MMC anschloss. Die Patienten wurden in 4 Behandlungsgruppen unterteilt: Bei Gruppe 1 erfolgte die Nachbeobachtung ohne MMC-Erhaltungsdosis; Gruppe 2 erhielt in den ersten 8 Wochen einmal pro Woche eine MMC-Instillation; Gruppe 3 erhielt in den ersten 8 Wochen einmal pro Woche und in den darauffolgenden 6 Monaten einmal pro Monat eine MMC-Instillation; Gruppe 4 erhielt in den ersten 8 Wochen einmal pro Woche und in den darauffolgenden 12 Monaten einmal pro Monat eine MMC-Instillation. ERGEBNISSE  Die allgemeine Rezidivrate lag bei 27,6 %. Gruppe 1 zeigte eine signifikant hohe (p < 0,05) Rezidivrate von 50 %, während sich bei den Rezidivraten der übrigen 3 Schemata kein Unterschied fand (Gruppe 2: 15 %; Gruppe 3: 24,1 %; Gruppe 4: 27,2 %). Darüber hinaus zeigte sich zwischen diesen Patientengruppen kein statistischer Unterschied bei den Rezidivraten von Ta- oder T1-Tumoren sowie niedrig- oder hochgradigen Tumoren. SCHLUSSFOLGERUNG  Unser Vergleich der verschiedenen Schemata einer intravesikalen MMC-Instillation ergab bei einer einzigen MMC-Instillation nach TURBT eine signifikant höhere Rezidivrate als bei Patienten, die nach 8 Wochen, 6 Monaten und 12 Monaten eine Erhaltungsdosis erhielten. Zeitlich fanden sich beim MMC-Erhaltungsschema keine signifikanten Unterschiede zwischen der 8. Woche und dem 12. Monat. Daraus folgern wir, dass bei T1 - oder Ta-High-Risk-NMIBC nach TURBT einmalig eine MMC-Instillation mit anschließender Erhaltungstherapie mit einmal wöchentlicher Verabreichung über 8 Wochen durchgeführt werden kann.

Symptomatic Lymphoceles Following Cadaveric Renal Transplantation: Single Center Experience

Post-transplantation lymphoceles are uncommon but troublesome problems. This study aimed to describe our experience of diagnosing and managing post-renal transplantation lymphoceles. We performed a retrospective chart-review of 94 consecutive cadaveric renal transplant recipients from March 2005 to August 2012 and identified five cases of lymphoceles occurring after transplantation. The demographic characteristics, comorbidities, occurrence of lymphoceles, and treatment modalities were analyzed. Five (5.3%) patients developed symptomatic postoperative lymphoceles; among them, four were male adults. In 80% of cases, diagnosis was made within 3 months after surgery. None of the lymphoceles were found within the first month after transplantation. Treatment with ultrasound-guided percutaneous drainage had a high success rate (80%) and was performed as first line therapy in all cases. One case experienced persistent drainage and required laparoscopic treatment. The mean follow-up period was 26±8 months (range: 15 - 38 months). All patients had improved renal function after the drainage procedure. No procedure-related complication occurred. Lymphoceles following cadaveric renal transplantation often occur in the second or third months after cadaveric renal transplantation, and can usually be managed with percutaneous drainage procedures. Treatment of lymphoceles also improved graft functions in the current study.