Chung-Bao Hsieh

The mechanisms of failure of totally implantable central venous access system: analysis of 73 cases with fracture of catheter.

BACKGROUND Totally implantable access ports are often used for the administration of chemotherapy or prolonged intravenous infusions in patients with cancer. The technique has been well described. However, some complications would happen. The pinch-off-syndrome is one of these complications. We report another presentation of pinch-off-syndrome and how to prevent. METHODS From January 2005 to December 2007, 73 patients of catheter fracture were collected. The duration of Port-A implantation ranged from January 2003 to October 2007. During this period, 3358 port-catheters were implanted. There were three brands of Port-A implanted included 46% BardPort (Bard, Salt Lake City, UT, USA), 42% A Port (Arrow international, Reading, PA, USA) and 12% PORT-A CATH (Deltec, St. Paul, MN, USA). RESULTS The most common clinical presentation was difficulty in injection in 32 cases (43.8%). The incidence of brand C was far lower than brand A and B. The most common site of fracture was at the proximal part (anastomosis between injection port and catheter) in 68 cases (93.2%). The incidence of fracture of Port-A was 6 in 738 (0.81%) in cut-down method; 67 in 2620 (2.56%) in percutaneous subclavian method. Most of the cases (34%) were no more than six months. CONCLUSION The most frequent location of fracture Port-A was in proximal part - anastomosis between injection port and catheter. The cause of easily fracture may be associated with pinch-off-syndrome and design of Port-A. This kind of fracture could be prevented by cut-down method and fixed one stitch in proximal part.

Gastric Residual Volume (GRV) and Gastric Contents Measurement by Refractometry

BACKGROUND Traditional use of gastric residual volumes (GRVs), obtained by aspiration from a nasogastric tube, is inaccurate and cannot differentiate components of the gastric contents (gastric secretion vs delivered formula). The use of refractometry and 3 mathematical equations has been proposed as a method to calculate the formula concentration, GRV, and formula volume. In this paper, we have validated these mathematical equations so that they can be implemented in clinical practice. METHODS Each of 16 patients receiving a nasogastric tube had 50 mL of water followed by 100 mL of dietary formula (Osmolite HN, Abbott Laboratories, Columbus, OH) infused into the stomach. After mixing, gastric content was aspirated for the first Brix value (BV) measurement by refractometry. Then, 50 mL of water was infused into the stomach and a second BV was measured. The procedure of infusion of dietary formula (100 mL) and then water (50 mL) was repeated and followed by subsequent BV measurement. The same procedure was performed in an in vitro experiment. Formula concentration, GRV, and formula volume were calculated from the derived mathematical equations. RESULTS The formula concentrations, GRVs, and formula volumes calculated by using refractometry and the mathematical equations were close to the true values obtained from both in vivo and in vitro validation experiments. CONCLUSIONS Using this method, measurement of the BV of gastric contents is simple, reproducible, and inexpensive. Refractometry and the derived mathematical equations may be used to measure formula concentration, GRV, and formula volume, and also to serve as a tool for monitoring the gastric contents of patients receiving nasogastric feeding.

Frequent concomitant epigenetic silencing of SOX1 and secreted frizzled-related proteins (SFRPs) in human hepatocellular carcinoma

Except for genetic mutations, epigenetic changes are also involved in the development of human cancers. Recently, we have identified SOX1, SRY (sex determining region Y)‐box 1, is hypermethylated in cervical cancer and ovarian cancer. Therefore, we investigated whether promoter hypermethylation of SOX1 is common in hepatocellular carcinoma (HCC).

Acute pulmonary embolism as the first manifestation of hepatocellular carcinoma complicated with tumor thrombi in the inferior vena cava: Surgery or not?

Acute pulmonary embolism as the first manifestation of hepatocellular carcinoma (HCC) complicated with tumor thrombi in the inferior vena cava (IVC) and right atrium is rare [1]. These patients usually die within a short period because of pulmonary embolism, heart failure, or cancer progression [2]. Here, we describe a 57-year-old man who had HCC complicated with tumor thrombi and pulmonary embolism. He was initially unwilling to undergo surgery but agreed to the surgery after developing a tumor thrombus of the right atrium followed within 24 hr by acute respiratory failure. He died from complications arising from surgery. We reviewed published reports of 14 patients who had HCC and pulmonary embolism. The 1-year survival rate was higher for patients who underwent surgery (40%) than for patients who did not undergo surgery (0%). Therefore, hepatic resection and removal of tumor thrombi should be considered to prolong the patient’s life span.

Spigelian hernia: Mesh or not?

OBJECTIVE: The purpose of this study was to report our experience in management and clinical result of Spigelian hernia with preperitoneal mesh repair or without mesh repair. EXPERIMENTAL DESIGN: Retrospecitve analysis. SUBJECTS: the medical records of 11 cases of Spigelian hernia with surgical treatment were reviewed. The clinical characteristic, treatment and clinical result were evaluated. RESULTS: of the 11 cases that were evaluated, 7 patients underwent open repair of hernia without extra-peritoneal mesh (group A), the other 4 patients underwent open surgery with extra-peritoneal mesh (group B). There were no significant difference in age, gender, body mass index, underlying diseases, symptoms, duration of symptoms, features of hernia sac and method of approach. No recurrence was found in these two groups. The mean follow-up time was 8.5 +/- 3.2 (years) in group A and 6.7 +/- 2.1 (years) in group B. CONCLUSIONS: whether open repair of spigelian hernia with or without extra-peritoneal mesh gives the same and well result.

The basal body gene, RPGRIP1L, is a candidate tumour suppressor gene in human hepatocellular carcinoma

Loss of heterozygosity (LOH) on chromosome 16q is one of the most frequent genetic alterations in hepatocellular carcinoma (HCC). Our previous data showed that the smallest common deleted region was between D16S415 and D16S419, encompassed approximately by a 0.75cM region on 16q12.2, suggesting that the putative tumour suppressor genes (TSGs) at this locus might be involved in the development of HCC. Of the four genes (CHD9, RBL2, AKTIP and RPGRIP1L) located in this region, only RPGRIP1L was downregulated in HCCs. Downregulation of RPGRIP1L was found in 91% (10/11) HCC cell lines and in 35% (14/40) HCCs, respectively. To investigate the role of RPGRIP1L in HCCs, we used the overexpression of RPGRIP1L in four HCC cell lines (HepG2, Huh6, Huh7 and Hep3B). Overexpression of RPGRIP1L suppressed colony formation of tumour cells. Conversely, expression of RPGRIP1LM (dominant negative form) in HCC cells enhanced colony formation. Furthermore, knockdown RPGRIP1L by RNA interference in SK-HepI cells promoted colony formation. Taken together, these data strongly suggest that RPGRIP1L might be the putative TSG in HCC. Moreover, we showed that Mad2, Survivin and Securin were elevated in RPGRIP1LM-HepG2 transfectants and RPGRIP1L-shRNA-SK-HepI transfectants. After knockdown of MAD2 in RPGRIP1L-shRNA-SK-HepI transfectants partly reverse cellular colony formation capability. These data suggest that RPGRIP1L suppresses anchorage-independent growth partly through the mitotic checkpoint protein Mad2.

Advanced age is not a contraindication for liver resection in cases of large hepatocellular carcinoma

BACKGROUND The role of surgery in the management of large hepatocellular carcinomas (HCCs) is controversial. Advanced age and comorbidities are taken into account when major surgery is considered. PURPOSE To compare the outcomes of liver resection (LR) and transarterial chemoembolization (TACE) for resectable HCC in patients aged 70 years or older. PATIENTS AND MATERIALS This study included 70 patients aged 70 years or older treated for large HCCs (≥5 cm) between January 2007 and December 2012: 37 underwent LR and 33 underwent TACE. The outcomes of these patients were retrospectively analyzed. Univariate and multivariate Cox proportional hazard models were established. Kaplan-Meier survival curves were generated, and survival data were compared using the log-rank test. RESULTS Hospital stay was significantly longer in the LR group than in the TACE group (10 days vs 8.5 days; P = 0.003). Treatment-related complications were more frequent in the TACE group, but this difference was not statistically significant. LR was associated with a better disease-free survival rate, median survival rate and cumulative overall survival rate. CONCLUSION Our results showed that LR could be a safe and effective treatment option for HCC tumors ≥5 cm in patiets aged 70 years or older.

A paraduodenal hernia (Treitz's hernia) causing acute bowel obstruction

Paraduodenal hernias, also called Treitz’s hernia, are unusual causes of intestinal obstruction and account for 0.9% of all intestinal obstructions (1). Paraduodenal hernias constitute half of all internal abdominal hernias and occur when the small bowel herniates into the paraduodenal fossa with manifestation of intestinal obstruction (2). Specific clinical signs are often absent, leading to the frequent delay of correct diagnosis, with bowel necrosis resulting in up to 20% of patients (3). Herein, we present our case to increase the awareness of Treitz’s hernia and suggest the early CT scan intervention may be helpful to make the preoperative diagnosis of paraduodenal hernia.

HCV core inhibits hepatocellular carcinoma cell replicative senescence through downregulating microRNA-138 expression

Hepatitis C virus (HCV) infection is a major cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). HCV core protein is considered as a positive regulator of telomerase activity. In this study, we focused on the deregulated microRNA-138 (miR-138) in HCV-associated HCC. Differential expression of miR-138 was determined by TaqMan quantitative real-time PCR. The target gene of miR-138 was verified by luciferase reporter assay, quantitative real-time PCR, and Western blotting. Moreover, three assays based on telomerase activity, cell proliferation, and senescence-associated β-galactosidase activity were performed. The correlation analysis revealed a significantly negative correlation between miR-138 and telomerase reverse transcriptase (TERT) mRNA expression in HCC. Further, we showed that mature HCV core protein of 173 amino acids, but not full-length form of 191 amino acids, suppressed miR-138 expression. TERT was verified as a direct target of miR-138 in HCC cells. Furthermore, TERT-targeting miR-138 supplementation can prevent HCV core protein from repressing HCC cell replicative senescence. Collectively, HCV core protein can enhance TERT protein expression through downregulating TERT-targeting miR-138 expression, which in turn inhibits HCC cell replicative senescence. This study may further help our understanding on the pathogenic mechanisms of HCV core protein in HCV-associated HCC development.Key messagemiR-138 is downregulated in HCV-associated HCC.Mature HCV core protein plays a pathogenic role in suppressing miR-138 expression.Telomerase reverse transcriptase represents a direct target of miR-138 in HCC cells.miR-138 promotes HCC cell senescence, suggesting potential for HCC treatment.

An unusual submucosal tumor of the cecum presenting a palpable abdominal mass: hepatoid carcinoma.

Hepatoid carcinoma is a special type of extrahepatic neoplasm presenting features of morphology, immunohistochemistry and biological behavior similar to hepatocellular carcinoma. It was first described in the stomach, which is the most common site and very rarely in the colon (1-2). The prognosis of hepatoid carcinoma is very poor compared with that of common types of adenocarcinoma. A prompt and accurate diagnosis of is important (3). We report here an unusual submucosal tumor of the cecum presenting a palpable abdominal mass, diagnosed as a hepatoid carcinoma by microscopic morphology and immunochemical staining. A 50-year-old woman developed presented with a palpable abdominal mass and intermittent diarrhea for 2 months associated with weakness and weight loss of 7 kilograms. Physical examination showed anemic conjunctiva and a 6-cm palpable, tender mass on right lower quadrant abdominal region. Laboratory data showed hemoglobin of 11.2 g/dl and normal values of tumor markers as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 and alpha-fetoprotein (AFP). Computed tomography (CT) of abdomen revealed a 8 cm x7 cm× 7 cm het-