Chih-Hsin Wang

Effects of the Anti-Epidermal Growth Factor Receptor Antibody Cetuximab on Cholangiocarcinoma of the Liver

Background: Cholangiocarcinoma is a malignant neoplasm arising from the biliary epithelium. The disease is notoriously difficult to diagnose and is usually fatal because of its late clinical presentation and the lack of effective nonsurgical therapeutic modalities. The overall survival rate, including in patients who underwent tumor resections, is poor, with less than 5% surviving more than 5 years. Over the past 5 years, several important studies have yielded new insight into the molecular mechanisms involved in the development and growth of these tumors. The tumor cells of the cholangiocarcinoma express an epidermal growth factor receptor which plays an important role in the pathogenesis of these tumors. Case Report: A 49-year-old woman with cholangiocarcinoma of the liver developed spinal metastases. The antiepidermal growth factor receptor (anti-EGFR) antibody was used successfully in combination with radiotherapy. The response to treatment was assessed by magnetic resonance imaging and positron-emission tomography. Conclusion: The patient with cholangiocarcinoma had a response to cetuximab-based therapies. This may lead to another option for the treatment of hepatic cholangiocarcinoma.

Small Bowel Perforation Secondary to Metastatic Lung Cancer: A Case Report with Literature Review

Lung cancer is usually diagnosed at an advanced stage, and metastases are present in 40% of patients. The preferential sites of extrapulmonary spread include lymph nodes, liver, brain, adrenal gland, and bone. Small bowel metastasis of lung cancer is a very rare occurrence and may be clinically missed due to the unspecificity of the symptoms. The prognosis is poor. Screening the bowel for metastatic disease cannot be recommended because of its low incidence. However, if a patient with lung cancer presents with gastrointestinal complaints, bowel enema and CT are helpful in diagnosis. Early diagnosis and surgical intervention leads to better palliation and short-term survival.

Blunt Abdominal Injury with Transection of Pancreatic Neck Detected Early by Abdominal Computed Tomography: A Case Report and Review of the Literature

Blunt abdominal trauma resulting in injury to the pancreas is relatively rare, but carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. Early recognition of disruption of the main pancreatic duct is important because such disruption is the principal cause of delayed complication. Abdominal CT gives the best opportunity for an immediate diagnosis. We herein report a case of transection of pancreatic neck from blunt abdominal trauma that was detected early by abdominal CT and managed by immediate distal pancreatectomy.

Anterolateral Thigh Flap in Pharyngoesophageal Reconstruction with Easy Flap Monitoring

Background: Pharyngoesophageal reconstruction with the anterolateral thigh (ALT) flap involves a buried free tissue transfer, and flap monitoring is important in this situation. Here we review our experience in pharyngoesophageal reconstruction using the ALT flap. Methods: Seven patients receiving pharyngoesophageal reconstruction (July 2006 through June 2009) were investigated noninvasively. All the patients were men with a mean age of 49 years. The pharyngoesophageal defects ranged from 6 to 11 cm in length (mean 8.07 cm), and circumferential defects were created after tumor ablation in four patients. Free ALT flaps were used in all patients for reconstruction and flap monitoring using an isolated distal perforator cutaneous flap was applied. Results: All reconstructive flaps survived in these patients without the need for a salvage procedure. Conclusions: The ALT is a useful flap for pharyngoesophageal reconstruction. It provides a single-stage procedure, including space filling, resurfacing of the neck skin and reliable flap monitoring.