Tsen-Long Yang

The Roles of Serum Leptin Concentration and Polymorphism in Leptin Receptor Gene at Codon 109 in Breast Cancer

Aims: We investigated the relationship between serum leptin concentrations and polymorphism of the leptin receptor gene and breast cancer. Methods: Serum leptin concentrations were measured by enzyme-linked immunosorbent assay in 47 women with invasive breast cancer compared with 41 age-matched controls without cancer. Genomic DNA was extracted from peripheral blood leukocytes. Genotyping of the leptin receptor gene at codon 109 (LEPR-109) was performed by polymerase chain reaction-restriction fragment length polymorphism. Results: Patients with breast cancer had a higher mean serum leptin concentration than women in the control group, but the difference was not statistically significant. Among those with breast cancer, the serum leptin concentration was higher in women with high-grade cancers (p = 0.020). The LEPR-109RR genotype was more frequent in premenopausal patients with tumors larger than 2 cm (p = 0.039) and in premenopausal women who were overweight (p = 0.029). Among patients with the LEPR-109RR genotype, higher mean serum leptin concentrations were present in those with triple-negative cancers (p = 0.048). Conclusions: Our study suggests an association between serum leptin concentration and tumor progression. LEPR-109 polymorphism in premenopausal women appears to be associated with obesity and tumor progression.

Clinicopathologic significance of leptin and leptin receptor expressions in papillary thyroid carcinoma

BACKGROUND Epidemiologic studies have shown that obesity is associated with an increased risk of thyroid cancer. Leptin, an adipocyte-derived cytokine, can act as a growth factor on certain normal and transformed cells. Aberrant expression of leptin or leptin receptor has been detected in some types of cancer. The aim of this study is to determine immunohistochemical expression of leptin and leptin receptor in papillary thyroid cancer to investigate the relationship between their expression and clinicopathologic features. METHODS The expression of leptin and leptin receptor was assessed in 49 primary neoplasms and 15 lymph node metastases using a semiquantitative immunohistochemical staining method. RESULTS Leptin and leptin receptor were expressed in 37% and 51% of papillary thyroid cancer, respectively. They were not expressed in normal follicles. In the primary neoplasms and the metastatic nodes, expression of leptin correlated closely with leptin receptor (P < .001 for the primary neoplasms and P = .017 for nodal metastases). Expression of either protein was associated with greater neoplasm size (leptin expression, 32.0 +/- 10.7 vs 20.5 +/- 8.4 mm; P = .001; leptin receptor expression, 27.9 +/- 11.5 vs 21.4 +/- 9.0 mm; P = .032). Coexpression of leptin and leptin receptor in primary neoplasms had greater incidence of lymph node metastasis (P = .038). CONCLUSION Expression of leptin and/or leptin receptor in papillary thyroid cancer is associated with neoplasm aggressiveness, including tumor size and lymph node metastasis.

Neurofibromatosis with gastrointestinal stromal tumors: insights into the association.

The frequent association of stromal tumors with neurofobromatosis raises high suspicion of a possible correlation between the two entities. The aim of this study was to analyze clinicopathologic features of patients with concomitant neurofibromatosis and gastrointestinal stromal tumors and to discuss the molecular basis for their possible pathogenesis. Detailed information about clinical presentation, histology, immunostains, polymerase chain reaction amplification, and sequencing in three of our own cases was obtained. Stromal tumors presented with abdominal pain in one case and hemorrhage in another. One patient underwent surgery for malignant transformation of neurofibroma and stromal tumors were found incidentally. Stromal tumors were consistently positive for CD117, while the malignant peripheral sheath tumor was not. Mutation in the KIT juxtamembrane domain was found in one case. In this respect, some stromal tumors lack demonstrable KIT mutations but KIT remains activated. We reasoned that other mechanisms, like the Ras pathway involved in neurofibromatosis type 1, might play a role in KIT activation.

Factors associated with prolonged stay after laparoscopic cholecystectomy in elderly patients

BackgroundLaparoscopic cholecystectomy in elderly patients has been linked to higher complication rates and longer lengths of stay. The purpose of this study was to identify risk factors associated with prolonged postoperative hospitalization in elderly patients undergoing laparoscopic cholecystectomy.MethodsThe records of 287 patients aged 65 years or older, who underwent successful laparoscopic cholecystectomy between January 2001 and July 2006, were retrospectively reviewed. Clinical data was abstracted from the chart and compared between patients with a shorter or longer postoperative stay.ResultsThe median postoperative hospital stay was three days (interquartile range 3–5). Forty-eight patients had complications, with an overall morbidity of 16% and mortality of 0.7%. The only independent predictor of prolonged postoperative stay was the occurrence of any major complication [odds ratio, 3.144; 95% confidence interval (CI), 1.882–5.251]. The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and underlying chronic obstructive pulmonary disease were independently associated with major complications.ConclusionsA major complication is the most important cause of prolonged hospital stay after laparoscopic cholecystectomy in the elderly. No specific comorbidity has direct impact on the duration of hospitalization, but pulmonary disease is associated with increased risk of major complications.

Large cell neuroendocrine carcinoma of the ampulla of Vater with glandular differentiation

Large cell neuroendocrine carcinoma of the ampulla of Vater is extremely rare. A 55 year old woman presented with an ampullary tumour causing pancreaticobiliary obstruction and a pancreaticoduodenectomy was performed. Microscopically, the tumour was diagnosed as a CD117 positive large cell neuroendocrine carcinoma with glandular differentiation. Four months later the patient developed a general recurrence. The metastatic tumours showed CD117 negativity and pure neuroendocrine features. The patient died of disease six months after diagnosis. It is postulated that the two components originated from a common multipotential stem cell. The clinical behaviour of ampullary large cell neuroendocrine carcinomas appears to be highly aggressive, with early metastases and a fatal outcome.

Choledochal cyst in adults: Aetiological considerations to intrahepatic involvement

Background:  Choledochal cysts are rare anomalies of the biliary tree and their presentation in adults is infrequent. The high incidence of associated anomalous pancreaticobiliary duct junction (APBDJ) has been well documented. However, the prevalence of APBDJ in different anatomic distribution of cysts has yet to be clarified.

Gender Differences Among Patients with Secondary Hyperparathyroidism Undergoing Parathyroidectomy

OBJECTIVE Female gender is associated with an increased risk of parathyroid nodular hyperplasia and parathyroidectomy rate in dialysis patients. The purpose of this study was to assess differences between women and men undergoing parathyroidectomy for secondary hyperparathyroidism. METHODS We reviewed 121 consecutive patients with end-stage renal disease and advanced secondary hyperparathyroidism who underwent parathyroidectomy between 2004 and 2007. Preoperative characteristics and short-term outcome of these patients were evaluated. RESULTS Compared with men (n = 43), women (n = 78) had lower preoperative bone mineral density (both T-scores and Z-scores) as well as lower preoperative hemoglobin levels. The cause of renal failure was also different between the two groups. No differences in preoperative calcium-phosphorus product, alkaline phosphatase, or parathyroid hormone levels were observed. Follow-up analysis showed that biochemical improvement and 1-y recurrence rate was similar between genders. CONCLUSION Women with secondary hyperparathyroidism had worse bone mineral metabolism before parathyroidectomy. Additional research regarding target organ susceptibility to hyperparathyroidism in different genders is warranted.

Perioperative Care of the Elderly

SUMMARY The geriatric population is growing in number and complexity in modern surgical practice. This challenging group presents differences in physiology and outcomes that make a more comprehensive and multidisciplinary approach necessary. This review emphasizes the meticulous assessment and preparation in all facets before surgery, including a thorough examination, nutrition evaluation and intervention, and preoperative optimization of pulmonary function and cardiovascular hemodynamics. This article highlights the importance of age-related pharmacokinetic and pharmacodynamic considerations, effective pain control, as well as prevention and treatment of hypothermia, fluid and electrolyte imbalance, and postoperative delirium. The vulnerable elderly patient with multiple medical problems and functional impairment is best served by a surgeon with a particular interest and working knowledge of the changes associated with aging and the physiology of surgery and anesthesia. [International Journal of Gerontology 2007; 1(2): 89–97]

Local Anesthesia to Improve Postoperative Outcome for Breast Cancer Surgery: Preliminary Results

Introduction: The purpose of this study was to determine safety and feasibility of breast surgery under local anesthesia (LA) combined with adequate sedation. Patients and Methods: Based on extensive satisfaction surveys, an anesthetic technique was developed that decreased nausea and pain, and reduced perioperative narcotic use. Using this new algorithm, patients treated by a single surgeon were given the choice of local anesthesia with adequate sedation. Results: From August 1, 2006 to December 31, 2007, 50 mastectomies or lumpectomy/axillary dissections were performed in 50 patients. Less postoperative nausea and vomiting (PONV) and less pain were noted in the LA group. Conclusions: Local block mastectomy can be safely performed. It can result in markedly improved postoperative outcome without incurring additional morbidity or mortality. Less nausea/vomiting and less pain infer better quality of cancer care and higher overall patient satisfaction.

Familial Thyroid Cancer

Familial thyroid cancer can arise from follicular cells (familial nonmedullary thyroid cancer, FNMTC) or from parafollicular cells (multiple endocrine neoplasia type Ⅱ, MEN2). Familial nonmedullary thyroid cancer occurs either as a discrete entity defined by the presence of thyroid cancers of follicular cell origin within two or more first-degree relatives or as part of other multitumor syndromes. FNMTC is associated with multifocality, aggressive behavior and frequent recurrences, and therefore should be treated aggressively. Family members are at an increased risk of developing thyroid cancer and need to be followed closely. For patients with medullary cancer, genetic testing for a RET mutation is necessary for timely detection of other MEN2 manifestations particularly pheochromocytomas and early identification of new family members who are gene carriers. Patients with MEN2B should undergo total thyroidectomy during infancy and prophylactic thyroidectomy should be performed in other gene carriers before 5 to 10 years of age. Clinicians must be aware of psychosocial and ethical issues related to patients with familial thyroid cancer and their family members.