Biomedical subjects

Miin-Fu Chen

Publications and source records attributed to Miin-Fu Chen.

At least 19 recordsLinked to original sources

PubMed2005

Gallbladder carcinoma with biliary invasion: clinical analysis of the differences from nonbiliary invasion.

Gallbladder carcinoma is the most common malignancy of the biliary tract. Because of a lack of specific presentations, this condition frequently is diagnosed only at an advanced stage. The clinical difference between gallbladder carcinoma with and without biliary involvement remains uncertain. This study recruited all patients with gallbladder carcinoma treated at Chang Gung Memorial Hospital (Taoyuan, Taiwan) from 1987 to 2002. The sample included 120 patients aged 28 to 91 years (mean 65.5 +/- 12.3 years) (39 men, 81 women), whose medical records were reviewed retrospectively. Based on the 2002 newly revised TNM classification, 25, 38, 28, and 29 patients had stage I, II, III, and IV disease, respectively. After we excluded patients with stage I, the other patients were classified into two groups as follows: group I, gallbladder carcinoma with biliary invasion (n = 41); group II, carcinoma without biliary involvement (n = 54). The clinical presentations, laboratory data, operative methods, and outcome of these two groups were compared. The two groups did not differ in terms of age, sex distribution, cholelithiasis, and most clinical presentations. Chemistry laboratory data also identified patients in group I with significantly elevated liver function tests. Group II had a borderline tendency toward better curative resectability than group I (p = 0.09). Survival was significantly better for group I patients who underwent curative resection (n = 5) via cholecystectomy, partial hepatectomy, and bile duct resection than for those with noncurative resection (p < 0.05). However, long-term survival demonstrated that gallbladder carcinoma had the same poor prognosis in the two groups. In conclusion, gallbladder carcinoma with biliary invasion has been found to a more overt clinical presentation and abnormal laboratory data, which might alert clinicians to consider gallbladder carcinoma at an advanced stage or biliary invasion and examine the underlying disease. Generally, the outcome of gallbladder carcinoma is dismal, and radical curative resection combined with cholecystectomy, partial hepatectomy, and bile duct resection perhaps may offer good benefits for advanced gallbladder carcinoma. Furthermore, surgical resection should be performed whenever possible in patients with gallbladder carcinoma to increase life expectancy.

Adult↗

PubMed2005

Surgical treatment of Hurthle cell tumors of the thyroid.

Hurthle cell tumors are relatively rare thyroid tumors and their management and prognosis is controversial. We retrospectively review 135 Hurthle cell adenomas and 28 Hurthle cell carcinomas of the thyroid surgically treated at our institute. No significant difference was found between the adenoma and carcinoma groups in patient age, gender, and tumor size. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of fine-needle aspiration cytology (FNAC) in detecting malignancy were 87.5%, 19.3%, 31.2%, 18.6%, and 88.0%. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of frozen section in detecting malignancy of the thyroid gland were 40.0%, 100.0%, 92.9%, 100.0%, and 92.0%. Most of the adenomas were treated with procedures no less invasive than lobectomy/isthmusectomy. Meanwhile, most of the carcinoma patients underwent total thyroidectomy. Operative morbidity occurred in six patients (3.8%), including transient recurrent laryngeal nerve palsy in three patients, damage to the external branch of the superior laryngeal nerve in two patients, and transient hypocalcemia in one patient. No recurrence of Hurthle cell adenomas was noted. Five adenoma patients died of causes unrelated to their Hurthle cell tumors, but no carcinoma patients died during the follow-up period. In conclusion, clinical factors and FNAC are not helpful in the differentiation between adenoma and carcinoma. Unilateral Hurthle cell adenoma can be treated by lobectomy/isthmusectomy, and Hurthle cell carcinoma can be treated by total thyroidectomy with minimal operative morbidity.

Adenoma, Oxyphilic↗

PubMed2005

Intrahepatic cholangiocarcinoma escapes from growth inhibitory effect of transforming growth factor-beta1 by overexpression of cyclin D1.

Transforming growth factor-beta1 (TGF-beta1) is involved in tumor progression by promoting angiogenesis or suppressing the immune system; yet TGF-beta1 also has a growth-inhibitory effect on epithelial cells including carcinoma cells. Several mechanisms of impaired TGF-beta1 responsiveness of carcinoma cells have been reported. In this study, we examined how TGF-beta1 participates in the development and progression of intrahepatic cholangiocarcinoma (ICC) associated with hepatolithiasis, and how ICC cells escape from growth inhibitory effect of TGF-beta1. A total of 40 cases of hepatolithiasis were studied, including 16 cases of ICC, and in vitro studies were conducted with cultured murine non-neoplastic biliary epithelial cells (MBEC) and three ICC cell lines. Immunohistochemically, TGF-beta1 was expressed in mononuclear cells and mesenchymal cells around the stone-containing bile ducts and invasive ICC, and also in biliary epithelial cells (hyperplastic and precursor lesions, and ICC). TGF-beta type II receptor (TbetaR-II) was constantly expressed on biliary epithelial cells irrespective of biliary lesions. In cell culture studies, TGF-beta1 significantly inhibited proliferation of MBEC via downregulation of cyclin D1, cdk4, and cdk6, while TGF-beta1 did not influence the proliferation of ICC cells. After suppression of cyclin D1 expression in one ICC cell line using cyclin D1 small interfering RNA, TGF-beta1 significantly inhibited the proliferation of ICC cells. In conclusion, high levels of TGF-beta1 around ICC or its precursors may be involved in development and progression of ICC in hepatolithiasis. ICC cells could escape the growth inhibitory effect of TGF-beta1 by overexpression of cyclin D1.

Cell Division↗

PubMed2004

Prognostic impact of Fas ligand on hepatocellular carcinoma after hepatectomy.

The expression of Fas ligand on tumor cells may counterattack the host's immunity and worsen the prognosis. Knowledge of the prognostic impact of Fas ligand on patients with hepatocellular carcinoma (HCC) after hepatectomy is still limited. Fas ligand expression in HCCs was examined in 59 patients who underwent hepatectomy for HCC. The prognosis was analyzed and correlated to the expression of Fas ligand. Expression of Fas ligand was detected by immunohistochemical staining in 27 of the 59 HCCs (45.8%). The Fas ligand was expressed in only a small number of cancer cells. However, even though only a few cancer cells expressed it, the prognosis for patients whose HCCs showed Fas ligand expression was worse than that for patients with an HCC without Fas ligand expression. The mean disease-free survival was only 10.83 +/- 1.90 months when HCCs expressed Fas ligand compared with 43.51 +/- 7.02 months for those without Fas ligand expression ( p = 0.0007). The overall patient survival was 28.34 +/- 4.08 months when the HCC expressed Fas ligand compared with 55.31 +/- 5.37 months for HCC without Fas ligand expression ( p = 0.0003). The expression of Fas ligand did not correlate with the presentation of other prognostic factors. Fas ligand expression is thus an independent prognostic factor for HCC. Thus the HCC expressing Fas ligand has a worse prognosis than the HCC without Fas ligand expression.

Adult↗

PubMed2004

Hepatic resection for hepatocellular carcinoma with obstructive jaundice due to biliary tumor thrombi.

Hepatocellular carcinoma (HCC) with obstructive jaundice due to biliary tumor thrombi is uncommon, and few studies have examined the outcome of hepatectomy for HCC with this unusual entity. This study examined the clinicopathologic factors influencing the outcomes of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi undergoing hepatectomy. The clinical features of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi (group A) undergoing hepatectomy from 1986 to 1998 were reviewed. The clinical features and factors influencing the outcome of 555 HCC patients without biliary tumor thrombi (group B) undergoing hepatectomy were used for comparison. Of 572 patients with surgically resected HCCs, 17 (3.0%) were classified into group A. Right upper quadrant pain, physical signs of jaundice, low albumin level, elevated bilirubin level, small tumor size, more vascular invasion, and tumor rupture were characteristic of group A patients. Multivariate stepwise logistic regression analysis revealed no independently significant factor differentiating group A patients from group B patients. The disease-free survival was similar between the group A and B patients, although group B patients exhibited significantly better overall survival (p = 0.014). Vascular invasion may adversely influence overall survival in group A patients undergoing hepatic resection (p = 0.0709). When feasible, hepatic resection is the preferred treatment for HCC patients with obstructive jaundice due to biliary tumor thrombi. It can achieve a disease-free survival comparable to that of HCC patients without biliary tumor thrombi. However, HCC patients with biliary tumor thrombi had significantly worse overall survival than did those without biliary tumor thrombi, especially those with concomitant vascular invasion.

Adolescent↗

PubMed2004

Surgical treatment of thyroid cancers with concurrent Graves disease.

BACKGROUND: Thyroid cancers with concurrent Graves disease are relatively rare. Accordingly, the natural history and optimal surgical treatment of thyroid cancers with Graves disease are controversial. METHODS: Sixty-one thyroid cancers with concurrent Graves disease were retrospectively reviewed. Histopathologic diagnoses included 58 papillary thyroid carcinomas (95.1%), 1 follicular carcinoma (1.6%), 1 medullary carcinoma (1.6%), and 1 Hürthle cell carcinoma (1.6%). RESULTS: The sample included 54 females and seven males. Subjects' ages ranged from 20 to 73 years (mean +/- SD, 35.9 +/- 10.6 years; median, 37 years). Average tumor size was 10.7 +/- 15.9 mm (range, 1-70 mm). Forty-nine tumors (80.3%) were 10 mm or smaller. Surgical procedures included subtotal thyroidectomy (40 patients), total thyroidectomy (16 patients), total thyroidectomy plus neck dissection (2 patients), near-total thyroidectomy (1 patient), and lobectomy with contralateral subtotal lobectomy (1 patient). Thirty-seven patients (60.7%) underwent postoperative 131I ablation for thyroid remnant. Neck lymph node metastases occurred in three patients and lung metastases in two patients. Patients who developed metastases were younger and had significantly larger tumors and higher pretreatment serum T3 level than those who did not develop metastases. No deaths occurred during the 6.2 +/- 4.1 year follow-up period (range, 1 year and 2 months to 18 years and 11 months). CONCLUSIONS: Most thyroid cancers with concurrent Graves disease were 10 mm or smaller. Subtotal thyroidectomy is adequate for patients with Graves disease with concurrent carcinoma 10 mm or smaller.

Adult↗

PubMed2004

Insular carcinoma: infrequent subtype of thyroid cancer with aggressive clinical course.

Data on four male and four female patients with insular carcinoma of the thyroid were reviewed to elucidate the clinical characteristics of this malignancy. The median age of the patients was 62.5 years (range 29-78 years). The size of the tumors ranged from 3.0 to 10.0 cm (median 4.7 cm). One patient with extensive neck disease and distant metastases underwent palliative debulking of the tumor mass and died of respiratory failure 10 days after surgery. Seven patients underwent total thyroidectomy. In addition to being given thyroxine supplement, three patients were treated with postoperative iodine-131 ((131)I) therapy, two with external radiation after (131)I treatment, and two with external radiation. Local invasion of the malignancy into strap muscles was observed in two patients, into the trachea in two patients, into the recurrent laryngeal nerve in one patient, and into the internal jugular vein in one patient. The median follow-up was 26 months (range 3-80 months). Lung metastases occurred in four patients and metastases at the neck lymph nodes in four patients; recurrence at the thyroid bed was observed in one patient. Four patients died of distant metastases and progressive recurrent disease. Of the three surviving patients, two remained disease-free, and one remained alive with lung metastases. In conclusion, insular carcinomas behave aggressively, so we believe they should be treated by total thyroidectomy plus neck dissection when nodal metastases are present.

Adult↗

PubMed2004

Resection of peritoneal implantation of hepatocellular carcinoma after hepatic resection: risk factors and prognostic analysis.

Peritoneal implantation from hepatocellular carcinoma (HCC) after hepatic resection is infrequent, and information on risk factors and long-term survival of such patients is lacking. The clinicopathologic features and risk factors of 16 HCC patients after hepatic resection who developed peritoneal implantation from an HCC and the prognosis after surgical resection of these HCC implants were assessed. The clinical features of 16 HCC patients after hepatic resection undergoing resection of peritoneal HCC implants (P-HCC) from 1986 and 2000 were reviewed. The clinical features and outcomes of 195 HCC patients undergoing hepatectomy without recurrence (NR-HCC) were used for comparison. During 1986 and 2000 a total of 749 HCC patients underwent hepatic resection. Of these 749 patients, 465 (62.1%) had HCC recurrence after hepatic resection during the follow-up period (median 26 months). Of the 465 patients, 26 (5.6%) developed peritoneal implants, and 16 of them underwent resection. Multivariate logistic regression analysis revealed that a high alpha-fetoprotein (AFP) level and capsular invasion by the tumor cells may predispose posthepatectomy patients to peritoneal implantation from their HCCs. The overall survival of the P-HCC patients after peritoneal implant resection was similar to that of the NR-HCC patients. An elevated AFP level might be regarded as a significant prognostic factor for poor overall survival ( p = 0.0577) after resection of peritoneal implants from HCCs. Peritoneal implantation occurs infrequently in posthepatectomy patients with an HCC. Elevated AFP values and capsule invasion by tumor cells may predispose posthepatectomy patients to peritoneal implantation from HCCs. Surgical resection of peritoneal implants from HCCs may prolong survival in selected patients. Elevated AFP levels may be regarded as a possibly significant prognostic factor for poor overall survival after resection of peritoneal HCC implants.

Adolescent↗

PubMed2004

Gasless video-assisted total thyroidectomy in the treatment of low risk intrathyroid papillary carcinoma.

Video-assisted thyroidectomy, although an increasingly used method to treat benign thyroid nodules, is rarely used to treat thyroid cancer. We performed gasless video-assisted total thyroidectomy for the treatment of papillary carcinoma of the thyroid. The patients were two men and five women with ages ranging from 29 to 52 years (median 35 years). Tumor size ranged from 0.7 to 3.8 cm (median 1.8 cm). The remnants of functional thyroid tissues were ablated with 1110 MBq of 131I following total thyroidectomy. One year after radioiodine ablation uptake of 74 MBq 131I shown by scintigraphy ranged from 0.29% to 0.70% (median 0.57%), and the serum thyroglobulin level was less than 1 microg/L. No perioperative complications occurred. The follow-up period ranged from 1 year 5 months to 3 years 7 months (median 2 years 10 months). In conclusion, gasless video-assisted total thyroidectomy is a feasible means for treating relatively small, non-invasive, clinically solitary, differentiated thyroid carcinomas.

Adult↗

PubMed2004

Influence of age on surgical treatment of peripheral cholangiocarcinoma.

BACKGROUND: Peripheral cholangiocarcinoma (PCC) constitutes the second most common primary liver cancer. Information is lacking on patients with PCC <40 years old undergoing surgical treatment. The aim of this study was to evaluate the influence of age on surgical treatment of patients with PCC based on reviewing the clinicopathologic features and survival rate of 23 patients with PCC <40 years old who received surgical treatment. METHODS: The clinical features of 23 younger patients with PCC (<40 years old) who underwent surgical treatment between 1977 and 2000 were reviewed. Clinical features of 284 patients with PCC >40 years old were used for comparison. RESULTS: Three hundred seven patients with PCC with an age range between 28 and 93 years (mean 57.2, median 56.0) were investigated. The fiftieth decade was the peak PCC age in the series. Clinical presentations and physical findings were similar between younger and older PCC groups. Similar positive serum carcinoembryonic antigen and carbohydrate antigen 19-9 rates (42.9% and 66.7% vs 41.2% and 74.4%, respectively) and a similar rate of hepatolithiasis associated with PCC were also observed between the 2 groups (43.5% vs 48.9%). Younger patients with PCC tended to show less mucobilia, less papillary-type PCC, and a more advanced stage of tumor compared with older patients with PCC. However, postoperative adjuvant chemotherapy and radiotherapy were used more frequently in the older patients with PCC. Operative morbidity and mortality were similar between the 2 groups (surgical mortality rate 7.8%). Follow-up ranged from 1.0 to 167.6 months (mean 13.0, median 5.7). The 1- and 2-year actuarial survival rates were 6.3% and 0% in the younger PCC group and 31.3% and 15.0% in the older PCC group, respectively. Prognosis was dismal for the younger patients with PCC (P = 0.0008), but they may benefit from hepatic resection. CONCLUSIONS: Younger patients with PCC had a significantly worse survival rate than older patients with PCC. Hepatectomy is rational and may benefit younger patients with PCC.

Adult↗

PubMed2004

Frequent p16ink4a inactivation is an early and frequent event of intraductal papillary neoplasm of the liver arising in hepatolithiasis.

Intraductal papillary neoplasm of the liver (IPNL) is a precursor lesion of intrahepatic cholangiocarcinoma (ICC) arising in hepatolithiasis. In this study, 98 foci of IPNL identified in 39 surgically resected hepatolithiatic livers were investigated for expression of p16INK4a, cyclin D1, p21WAF1/CIP1, p53, mouse double-minute 2 (MDM2), and pRb. In addition, methylation-specific polymerase chain reaction (MSP) for p16 INK4a promoter region was performed in these foci. Nonneoplastic bile ducts from 11 hepatolithiatic livers, 5 histologically normal livers, and 9 cases of nonpapillary conventional ICC were used as controls. Decreased expression of p16INK4A was seen in IPNL group 1 with mild dysplasia and continued along the progression of IPNL to ICC. The expression of cyclin D1, p21WAF1/CIP1,and pRb gradually increased along the progression of IPNL to ICC and became significantly high in IPNL of group 3 (carcinoma in situ). The expression of p53 and MDM2 was increased in IPNL group 3 and group 4 with evident invasive carcinoma. MSP revealed that 54.6% of 44 IPNL foci harbored p16INK4a promoter hypermethylation, and such foci were significantly correlated with decreased expression of p16INK4a protein. Ki-67 labeling index exhibited a stepwise increase from IPNL group 1 to group 4. We conclude that p16INK4a inactivation, due mainly to its promoter hypermethylation, is a frequent and early event of IPNL and may be responsible for genetic and epigenetic alterations of other cell cycle regulators in IPNL.

Adenoma, Bile Duct↗

PubMed2004

Thalidomide salvages lethal hepatic necroinflammation and accelerates recovery from cirrhosis in rats.

BACKGROUND/AIMS: The authors investigated the feasibility of thalidomide employed to treat liver fibrosis. METHODS: A cirrhotic model was established using Sprague-Dawley rats fed thioacetamide. Thalidomide-treated group was given thalidomide (10mg/kg/day) intraperitoneally for 10 consecutive days. Mortality, histopathological changes, TNFalpha, TGFbeta1, TIMP-1 and TIMP-2 were determined. Expression of TNFalpha and TGFbeta1 mRNA of Kupffer's cells derived from the experimental rats were determined. RESULTS: The mortality rates of thalidomide-treated group and vehicle-treated group were 8 and 32%, respectively. The total Knodell score of thalidomide-treated rats was lower than those of vehicle-treated rats. Micro-nodular cirrhosis resolved grossly in thalidomide-treated rats on day 28; while vehicle-treated rats continued to display uneven liver surface on day 28. Expression of TNFalpha, TGFbeta1, TIMP-1, and TIMP-2 was decreased in thalidomide-treated rats compared to those treated with vehicles. Finally, the expression of TNFalpha and TGFbeta1 mRNA of Kupffer's cells derived from rats treated with thalidomide were much lower than those treated with vehicle. CONCLUSIONS: Thalidomide salvages lethal hepatic necroinflammation, accelerates recovery from cirrhosis in rats, and works by suppressing of TNFalpha and TGFbeta1 production of Kupffer's cells.

Animals↗

PubMed2004

Functional impairment of dendritic cells caused by murine hepatocellular carcinoma.

Immunosuppression in tumor-bearing hosts may be a major obstacle in eradicating tumors. This study investigated whether hepatocellular carcinoma suppressed the functions of dendritic cells to escape tumor surveillance. Dendritic cells (DC), propagated from C57BL/10J mice, were cocultured with or without murine hepatoma Hepa1-6 cells to examine the influence of hepatocellular carcinoma on dendritic cells. The results revealed that dendritic cells cocultured with hepatoma cells expressed low levels of costimulatory molecules, and the stimulatory capacity was decreased. The antigen-specific cytotoxic effects of T cells activated by the DC cocultured with hepatoma cells were also decreased. In ex vivo studies, the maturation and function of dendritic cells propagated from tumor-bearing mice were suppressed. The suppressive effect of Hepa1-6 cells on dendritic cells could be partially reversed by neutralizing IL-10. In conclusion, the maturation and stimulatory function of DC are suppressed by hepatocellular carcinoma. IL-10 release may be one of the mechanisms employed by hepatocellular carcinoma to suppress dendritic cells.

Animals↗

PubMed2004

Aberrant expression of CDX2 is closely related to the intestinal metaplasia and MUC2 expression in intraductal papillary neoplasm of the liver in hepatolithiasis.

Intraductal papillary neoplasia of the liver (IPNL) frequently presents gastrointestinal metaplasia with aberrant expression of MUC2 and MUC5AC and oversecretion of mucin into the ductal lumen. In this study, the involvement of CDX2, a homeodomain protein involved in the regulation of intestinal development and differentiation, in the expression of MUC2 was examined in mucinous intrahepatic cholangiocarcinoma (ICC) (n=7) and IPNL with hepatolithiasis (n=19) with comparison to conventional ICC (n=11), and intraductal papillary mucinous tumor and invasive ductal carcinoma of the pancreas (n=9 and 11, respectively). A total of 33 cases of hepatolithiasis, extrahepatic biliary obstruction and normal livers were used as the control. Immunohistochemically, both MUC2 and MUC5AC were frequently expressed in mucinous ICC and IPNL, while expression of MUC2 was not seen in conventional ICC. The nuclear expression of CDX2 was closely associated with the expression of MUC2 in mucinous ICC and IPNL. This intimate association of MUC2 and CDX2 was confirmed by double immunostaining. The cytoplasmic CDX2 expression was frequent in the mucinous and the conventional ICC and pancreatic carcinoma, irrespective of MUC2 and MUC5AC expression. CDX2 mRNA was detected in neoplastic cells showing cytoplasmic as well as nuclear expression of CDX2 by reverse transcriptase-polymerase chain reaction. One IPMT expressed MUC2 associated with nuclear CDX2 expression, while the other IPMT and conventional pancreatic carcinoma expressed MUC5AC only. Aberrant expression of CDX2 is closely related to the overexpression of MUC2 in mucinous ICC and IPNL associated with hepatolithiasia, suggesting its role in intestinal differentiation and its association with carcinogenesis in these tumors.

Adult↗

PubMed2004

Endo-GIA for ligation of dilated cystic duct during laparoscopic cholecystectomy: an alternative, novel, and easy method.

BACKGROUND: This study prospectively assessed the efficacy and applicability of Endo-GIA for difficult and dilated cystic duct (CD) closure in 24 patients undergoing laparoscopic cholecystectomy (LC) due to CD stone. METHODS: From January 1998 to December 2002, 3325 patients underwent LC for gallbladder lesions at the department of general surgery at Chang Gung Memorial Hospital (Taipei, Taiwan), and 24 (0.72%) were identified as having dilated and difficult CD, which were ligated by Endo-GIA. This study prospectively followed these 24 patients and evaluated the management outcomes. The indications for LC in the 24 patients were symptomatic gallstones with or without common bile duct (CBD) stones (11 patients), Mirizzi syndrome type I (two patients), acute cholecystitis (five patients), acute cholecystitis with acute cholangitis (two patients), acute cholangitis (one patient), biliary pancreatitis (two patients), and gallbladder polyp (one patient). RESULTS: No patients required conversion to open surgery. The CD were successfully ligated with Endo-GIA in all 24 patients with dilated and difficult CD during LC. The postoperative course was uneventful except in two patients. One patient suffered bile duct injury (Stewart-Way class II), and was managed successfully by repeated endoscopic stent. The other case was complicated with retained CBD stone due to migration of fragmented CD stone and was managed by endoscopic papillotomy and stone retrieval. Followup ranged from 1 to 40.2 months (median, 18.5 months) and no other complications were discovered during the followup period. CONCLUSIONS: Endo-GIA is a safe and effective procedure for closing dilated and difficult CD. Endo-GIA could alternatively be attempted in other selected cases because of its ease of application.

Adult↗

PubMed2004

Video-assisted open thyroid lobectomy through a small incision.

To examine if postoperative morbidity may occur in gasless video-assisted thyroid lobectomy, 111 patients with solitary nodules were treated either by gasless video-assisted lobectomy or by conventional lobectomy. Operating time needed for video-assisted lobectomy significantly exceeded that needed for conventional surgery. No death, massive hemorrhage, wound hematoma, wound infection, or permanent recurrent laryngeal nerve injury occurred in patients treated by either video-assisted or conventional lobectomy. Damage to the external branch of the superior laryngeal nerve occurred in 6 (10.2%) patients following conventional surgery but in no patients following video-assisted lobectomy (P = .0289). Transient recurrent laryngeal nerve palsy occurred in 5 (8.5%) patients after conventional surgery and in 3 (5.8%) patients after video-assisted surgery (P = .7209). It is noteworthy that morbidity occurs in video-assisted lobectomy. The general principles of thyroid surgery should be followed to avoid the occurrence of complications.

Adolescent↗

PubMed2004

Expression of epidermal growth factor receptor, apomucins, matrix metalloproteinases, and p53 in rat and human cholangiocarcinoma: appraisal of an animal model of cholangiocarcinoma.

OBJECTIVE: We sought to determine the expression of molecular markers in an animal model of cholangiocarcinoma compared with those in human cholangiocarcinoma. SUMMARY BACKGROUND DATA: Cholangiocarcinoma is a rare disease characterized by early intrahepatic and extrahepatic spread, which seriously limits the efficacy of surgery. Establishing an experimental model to study the cholangiocarcinogenesis is desirable. METHODS: Sprague-Dawley rats weighing 300 +/- 50 g were used for the study group. The animals were given 0.3% thioacetamide in tap water continuously. Thirty mass-forming peripheral cholangiocarcinoma patients also were studied. Expression of epidermal growth factor receptor (EGFR), MUC1, MUC2, MUC5AC, MMP-2, MMP-9, and p53 in both human and experimental rat cholangiocarcinoma was examined using immunohistochemistry. RESULTS: Using thioacetamide 0.3% as a hepatoxin to induce cholangiocarcinoma in rats, microfoci of cancerous cells were detected from 12 weeks, and all experimental rats displayed diffuse mass-forming cholangiocarcinoma after 24 weeks. EGFR was strongly expressed in 14 (47%) of 30 human cholangiocarcinoms and 24 (100%) of 24 rat cholangiocarcinomas, respectively. MUC1 was strongly expressed in all human and rat cholangiocarcinomas, whereas MUC2 and MUC5AC were focally and weakly expressed. MMP-2 and MMP-9 were strongly expressed in 22 (73%) of 30 human cholangiocarcinomas and 24 (100%) of 24 rat cholangiocarcinomas, respectively. p53 overexpression was detected in 9 (30%) of 30 human cholangiocarcinoma and none of the rat cholangiocarcinoma, respectively. CONCLUSIONS: The expression of EGFR, apomucins, MMPs, and p53 in rat cholangiocarcinoma was strongly homologous to human cholangiocarcinoma. Thioacetamide-induced cholangiocarcinoma in rats provides an excellent model for investigating cholangiocarcinogenesis in vivo.

Animals↗

PubMed2004

Hepatic resection of the intraductal papillary type of peripheral cholangiocarcinoma.

BACKGROUND: Peripheral cholangiocarcinoma (PCC) can be grossly classified into mass-forming, periductal-infiltrating, and intraductal papillary (IP) types. Information on IP-PCC patients undergoing hepatectomy is sparse because of the small number of cases. METHODS: The clinical features of 40 IP-PCC patients undergoing hepatectomy between 1977 and 2000 were reviewed. The clinical features of 94 PCC patients without IP growth undergoing hepatectomy were used for comparison. RESULTS: IP-PCC and non-IP-PCC groups had similar age distributions (P =.674), sex ratios (P =.079), and positive rates for serum carcinoembryonic antigen and CA 19-9 (P =.121 and.795, respectively). The two groups also exhibited similar rates of association between hepatolithiasis and PCC (P =.230). However, more IP-PCC patients exhibited signs during admission, and more had ALT values >36 IU/L; they also had smaller tumors, more mucobilia association, and tumors in earlier stages and had undergone more postoperative chemotherapy. Multivariate logistic regression analysis showed that only ALT >36 IU/L differentiated IP-PCC from non-IP-PCC patients. The two groups exhibited similar operative mortality (P = 1.0). Follow-up ranged from 1.6 to 125.2 months (mean and median, 44.6 and 5.7 months, respectively). The 1-, 3-, and 5-year overall survival rates were 72.9%, 41.2%, and 24.7%, respectively, in the IP-PCC group and 43.3, 6.03%, and 2.01% in the non-IP-PCC group. The prognosis was favorable for the IP-PCC patients (P <.00001), particularly for IP-PCC patients who received curative hepatectomy (P =.013). CONCLUSIONS: IP-PCC patients had significantly better survival than non-IP-PCC patients, and aggressive curative hepatic resection is associated with a longer survival.

Adult↗