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Ming-Kuen Lai

Publications and source records attributed to Ming-Kuen Lai.

18 recordsLinked to original sources
PubMed2006

Laparoscopic adrenalectomy for potentially malignant adrenal tumors greater than 5 centimeters.

PURPOSE: Laparoscopic adrenalectomy (LA) is controversial for large, potentially malignant tumors. We report a series of LA or hand-assisted LA for large (>5 cm) adrenal tumors. PATIENTS AND METHODS: Among 210 LAs performed in 6 yr, 39 patients had potentially malignant tumors greater than 5 cm in diameter. Their perioperative and follow-up data were retrospectively analyzed. RESULTS: All 39 patients had successful LAs without perioperative mortality, conversion to open surgery, or capsular disruption during dissection. The mean tumor size was 6.2 cm (range, 5-12 cm), operative time 207 min (115-315 min), and blood loss 75 ml (minimal-1400 ml). Complications included one intraoperative diaphragmatic perforation, three mild wound infections, and one pneumonia. Preoperatively there were 27 nonfunctioning tumors, seven pheochromocytomas, three cortisol-secreting tumors, and two virilizing tumors. Final pathology revealed eight malignant (four adrenocortical carcinomas and four metastatic carcinomas) and 31 benign tumors (14 cortical adenomas, eight pheochromocytomas, six myelolipomas, and three ganglioneuromas). Median follow-up was 39 months. Four patients (two adrenocortical carcinomas, one metastatic hepatoma, and one lymphoma) died 24, 10, 9, and 3 months after surgery, respectively. A hand-assisted device was used in 10 patients. Only the tumor size was larger and length of postoperative hospital stay longer for those in the hand-assisted group. CONCLUSIONS: LA is a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion. Hand-assisted LA is a good alternative to open conversion if a difficult dissection is encountered intraoperatively.

Adenoma↗
PubMed2006

Identification of differentially expressed genes in clear cell renal cell carcinoma by analysis of full-length enriched cDNA library.

Renal cell carcinoma (RCC) is the most common malignancy in adult kidney, and accounts for 3% of malignancies worldwide with increasing incidence. Clear cell RCC (ccRCC) is the major type in RCC. Resection by surgery is the main treatment because the response of ccRCC to traditional therapies is very poor. To identify the tumor-associated genes for better understanding the molecular mechanism of ccRCC, the full-length enriched cDNA libraries of ccRCC and normal kidney tissues were constructed by the oligo-capping method. Nucleotide sequences of the cDNA libraries of ccRCC and normal kidney tissues were sequenced. From the sequence analysis of 19,425 and 12,400 clones of ccRCC and normal kidney tissues, 4356 and 3055 genes were identified, respectively. By comparing the gene-expression patterns of ccRCC and normal tissues, the up- or down-regulated genes were identified. Among these identified genes, the differential expression of annexin A2 and argininosuccinate synthetase genes were further confirmed by quantitative real-time PCR and Western blot analysis.

Annexin A2↗
PubMed2006

Discontinuation of lamivudine treatment for hepatitis flare after kidney or heart transplantation in hepatitis B surface antigen-positive patients: A retrospective case series.

BACKGROUND: Limited data are available on the clinical course of hepatitis B virus (HBV) infection after discontinuation of lamivudine prescribed for kidney or heart posttransplantation hepatitis flare OBJECTIVE: The purpose of this study was to investigate the reasons for discontinuation, subsequent reappearance of HBV DNA, and mortality in heart and kidney transplant recipients who discontinued lamivudine treatment. METHODS: This retrospective case series followed up male and female hepatitis B surface antigen (HBsAg)-positive Taiwanese transplant recipients from the National Taiwan University Hospital, Taipei, Taiwan, between July 1989 and January 1999. Biochemical, virologic, and serologic parameters and liver-related mortality of patients who discontinued lamivudine 100 mg QD prescribed for posttransplantation hepatitis flare were compared with those in a group of patients who continued use of lamivudine administered for the same indication over the same period of time. Serum HBV DNA levels were checked in all patients before and after discontinuation of lamivudine, and after resumption of lamivudine treatment and in patients with breakthrough hepatitis flare. RESULTS: A total of 39 HBsAg-positive transplant recipients (mean [SD] age, 45 [10.0] years) were identified during regular follow-up visits. Nine patients discontinued lamivudine use; 11 patients who continued it were selected as a control group. No significant between-group differences were observed in mean (SD) age (46 [14.0] vs 45 [6.9] years), sex (men/women,vs 1), type of transplant received (heart/kidney,vs ), or pretransplantation liver function test results. The reasons for discontinuation were informed patient decision (4 patients); YMDD mutation (2); self-discontinuation without physician consultation (2); and pregnancy (1). Of those who discontinued lamivudine, serum HBV DNA was undetectable at a mean of 30 (range, 9-47) months' follow-up in 6 (66.7%) of 9 patients. Lamivudine treatment was resumed in 3 patients on reappearance of HBV DNA, and a subsequent rapid decline in the serum HBV DNA was observed. The liver-related mortality rate was not significantly higher in patients who discontinued treatment compared with continuously treated patients (both, 0%). The between-group difference in overall mortality rates was not significant (22.2% and 18.2%, respectively). CONCLUSIONS: This case series illustrated a variety of clinical situations in which discontinuation of lamivudine treatment prescribed for posttransplantation hepatitis flare may occur. However, liver-related mortality was not increased in these patients compared with those who continued lamivudine treatment.

DNA, Viral↗
PubMed2006

High incidence of and risk factors for metachronous bilateral upper tract urothelial carcinoma in Taiwan.

AIM: Urothelial carcinoma (UC) can occur multifocally in the whole urothelium. A higher rate of bilateral metachronous upper tract (UT) UC was noted in Taiwan. The incidence and risk factors were largely unknown and hence were explored in the study. METHODS: From January 1977 through June 2003, 462 patients with unilateral UT-UC were studied retrospectively. The cumulative incidence of contralateral recurrence was analysed with the Kaplan-Meier analysis. Potential risk factors for contralateral recurrence including age, smoking, bladder cancer, renal function, diagnostic year etc. were evaluated with the log-rank test. Independent risk factors were identified by using the Cox regression analysis. RESULTS: The median follow-up time was 34 months (6-337). Among the 462 patients, 52 (11.3%) developed metachronous contralateral UC. The 2, 5, and 10-year contralateral disease-free survivals were 93.5%, 84.0%, and 75.7%, respectively. The median time to contralateral recurrence was 31.0 months. With the univariate analysis, only poor renal function (serum creatinine < or > OR =2.0 mg/dL, P < 0.001) and late diagnostic year (before or after 1990, P < 0.001) were risk factors for contralateral recurrence. In the multivariate analysis, poor renal function (hazard ratio: 2.98; 95% confidence interval: 1.67-5.33; P < 0.001) and late diagnostic year (hazard ratio: 4.27; 95% confidence interval: 1.71-10.65; P = 0.002) remained independent risk factors. CONCLUSIONS: The incidence of metachronous UT-UC is high in Taiwan. Patients who had either chronic renal insufficiency or a disease diagnosed after 1990 had a higher risk of contralateral recurrence.

Adolescent↗
PubMed2005

Expanding the donor pool: use of renal transplants from non-heart-beating donors supported with extracorporeal membrane oxygenation.

In response to organ shortage, we used the renal grafts from non-heart-beating donors (NHBDs). Extracorporeal membrane oxygenation (ECMO) was used to maintain NHBDs before organ procurement. We compared the results of renal transplantation from different donors, including heart-beating donors (HBDs), living-related donors (LDs), and NHBDs supported with ECMO. From February 1998 to June 2003, we recruited 219 patients receiving renal transplantation at National Taiwan University Hospital. Among them, 31 received kidneys from NHBDs supported with ECMO, 120 from HBDs, and 68 from LDs. Multiple organ transplant recipients were not included in this study. We compared the graft survival, serum creatinine levels, and estimated glomerular filtration rates of the three groups. The rate of delayed graft function was higher in NHBD recipients (41.9%) than in HBD recipients (27.0%) and LD recipients (10.9%) (p = 0.003). In the NHBD group, the recipients of grafts with delayed function had significantly longer ECMO runs (63.1 +/- 3.0 min) than those without delayed function (53.7 +/- 2.5 min) (p = 0.024). Estimated glomerular filtration rate (p = 0.472) and mean serum creatinine level (p = 0.286) were not significantly different between the three groups using a longitudinal approach. The 5-yr graft survival rates for NHBD (88.4%, 95% CI: 0.680-0.962), HBD (83.2%, 95% CI: 0.728-0.899), and LD transplant recipients (89.3%, 95% CI: 0.619-0.974) were not significantly different (p = 0.239). The 5-yr patient survival rates for NHBD, HBD, and LD transplant recipients were 100, 93.0 (95% CI: 0.859-0.966) and 100% respectively. The long-term allograft survival and function of kidneys from NHBDs supported by ECMO, HBD, and LD did not differ significantly. Long ECMO running time tended to delay graft function.

Adult↗
PubMed2005

Adenovirus-mediated bcl-2 gene transfer inhibits renal ischemia/reperfusion induced tubular oxidative stress and apoptosis.

Ischemia/reperfusion induces oxidative injury to proximal and distal renal tubular cells. We hypothesize that Bcl-2 protein augmentation with adenovirus vector mediated bcl-2 (Adv-bcl-2) gene transfer may improve ischemia/reperfusion induced renal proximal and distal tubular apoptosis through the mitochondrial control of Bax and cytochrome C translocation. Twenty-four hours of Adv-bcl-2 transfection to proximal and distal tubular cells in vitro upregulated Bcl-2/Bax ratio and inhibited hypoxia/reoxygenation induced cytochrome C translocation, O(2) (-) production and tubular apoptosis. Intra-renal arterial Adv-bcl-2 administration with renal venous clamping augmented Bcl-2 protein of rat kidney in vivo in a time-dependent manner. The maximal Bcl-2 protein expression appeared at 7 days after Adv-bcl-2 administration and the primary location of Bcl-2 augmentation was in proximal and distal tubules, but not in glomeruli. With a real-time monitoring O(2) (-) production and apoptosis analysis of rat kidneys, ischemia/reperfusion increased renal O(2) (-) level, potentiated proapoptotic mechanisms, including decrease in Bcl-2/Bax ratio, increases in caspase 3 expression and poly-(ADP-ribose)-polymerase fragments and subsequent proximal and distal tubular apoptosis. However, Adv-bcl-2 administration significantly enhanced Bcl-2/Bax ratio, decreased ischemia/reperfusion induced O(2) (-) amount, inhibited proximal and distal tubular apoptosis and improved renal function. Our results suggest that Adv-bcl-2 gene transfer significantly reduces ischemia/reperfusion induced oxidative injury in the kidney.

Adenoviridae↗
PubMed2004

Catechins prevents substance P-induced hyperactive bladder in rats via the downregulation of ICAM and ROS.

We previously reported substance P (SP) via neurokinin type 1 receptor facilitates bladder afferent signaling and reactive oxygen species (ROS) formation in bladder connected with neurogenic inflammation [Am. J. Physiol. Renal Physiol. 284 (2003) F840]. Increased intercellular adhesion molecule expression and subsequent leukocyte adhesion in the inflamed bladder contribute to SP-induced oxidative injury. Here we investigate the effect of green tea extract (catechins) on SP-induced bladder hyperactivity. We evaluated isovolumetric cystometrogram, adhesion molecular expression, and ROS activity in anesthetized rat bladder with SP stimulation. Our results showed that SP increased the amount of leukocyte ROS production in vitro in a dose-dependent manner and the enhanced ROS can be inhibited by catechins treatment. Exogenous SP increased ROS in vivo in the bladder via increased intercellular adhesion molecule expression and subsequent leukocyte adhesion, a primary source of ROS in the inflamed bladder. Two weeks of catechins pretreatment reduced SP-induced bladder intercellular adhesion molecule expression and ROS amount and ameliorated the hyperactive bladder response. These results indicate that catechins pretreatment can ameliorate SP-induced neurogenic inflammation via the action of antioxidant, anti-adhesion, and anti-inflammatory activity.

Animals↗
PubMed2004

Interleukin-6 is responsible for drug resistance and anti-apoptotic effects in prostatic cancer cells.

BACKGROUND: Interleukin (IL)-6-mediated anti-apoptotic effects and drug-resistance mechanisms in prostate cancer cells were investigated. METHODS: IL-6 levels of PC-3 and LNCaP cells were studied by using ELISA. Protective effects of IL-6 on cytotoxic agent-induced apoptosis were studied by exogenous IL-6 in serum-starved PC-3 cells and by anti-sense IL-6 strategy. Western blotting and reverse transcription-polymerase chain reaction (RT-PCR) were used to determine IL-6 effects on Bcl-2 family proteins. Tetracycline-regulated Bcl-xL expression system and dominant negative STAT3 transfectants were used to study IL-6 signaling pathways and its anti-apoptosis effects. RESULTS: Exogenous IL-6 and anti-sense IL-6 oligonucleotide treatment conferred resistance to cytotoxic agent-induced apoptosis. Among Bcl-2 family proteins, only Bcl-xL was evidently increased by IL-6 stimulation. The anti-apoptotic effect of IL-6 can be significantly attenuated by anti-sense bcl-xL transfection and partially abrogated in dominant negative STAT3 transfectants. CONCLUSIONS: IL-6 is a survival factor against cytotoxic agent-induced apoptosis through both STAT3 and bcl-xL pathways in prostate cancer cells.

Acute-Phase Proteins↗
PubMed2003

Hypoxia preconditioning attenuates bladder overdistension-induced oxidative injury by up-regulation of Bcl-2 in the rat.

We explored whether hypoxic preconditioning minimizes oxidative injury induced by overdistension/emptying in the rat bladder. For hypoxic preconditioning, female Wistar rats were placed in a hypobaric chamber (380 Torr) 15 h day(-1) for 28 days. Overdistension was induced by infusion of two times the threshold volume of saline into the bladder and was maintained for 1 or 2 h, followed by drainage/emptying. During overdistension (ischaemia) and emptying (reperfusion) periods, a bursting increase of reactive oxygen species (ROS) from the bladder was originated from the large numbers of infiltrating leucocytes and scattered resident cells, including urothelial, submucosal, and smooth muscle cells. ROS impaired the voiding function by a reduction of bladder afferent and efferent nerve activity and bethanecol- or ATP-induced detrusor contraction. ROS enhanced pro-apoptotic mechanisms, including increases in the Bax/Bcl-2 ratio, CPP32 expression, and poly(ADP-ribose) polymerase (PARP) fragments with subsequent apoptotic cell formation in the insulted bladders. Hypoxia preconditioning up-regulated Bcl-2 expression in the bladder and significantly reduced the levels of ROS and apoptosis detected in the overdistension/emptying bladders and preserved partial voiding function. Bcl-2 up-regulation by hypoxia preconditioning contributes protection against overdistension/emptying-induced oxidative stress and injury in the bladder.

Animals↗
PubMed2003

Substance P via NK1 receptor facilitates hyperactive bladder afferent signaling via action of ROS.

We explored whether substance P (SP) via neurokinin (NK) receptor facilitates bladder afferent signaling and reactive oxygen species (ROS) formation in bladder in association with neurogenic inflammation. We evaluated ROS activity and cystometrograms as well as pelvic nervous activity in anesthetized rat bladder with SP stimulation. Our results showed that endogenous SP via NK(1), not NK(2), receptor mediated a micturition reflex. An increase in SP by electrical stimulation of the pelvic nerve or an increase in exogenous SP by intra-arterial or intrathecal administration can facilitate myogenic and neurogenic bladder contractions. Furthermore, exaggerated SP release increased ROS in the bladder and whole blood via increased mast cell degranulation, intercellular adhesion molecule expression, and leukocyte adhesion, a primary source of ROS in the inflamed bladder. Treatment with NK(1)-receptor antagonists or ROS scavengers reduced bladder intercellular adhesion molecule expression and ROS and ameliorated the hyperactive bladder response. Our study indicates that the mechanism by which SP participates in the neurogenic bladder may be complicated by its proinflammatory activity and its ability to stimulate ROS generation.

Animals↗
PubMed2002

Clipless laparoscopic adrenalectomy with needlescopic instruments.

PURPOSE: We describe our experience with clipless laparoscopic adrenalectomy using needlescopic instruments. We compared the results with those of a contemporary series of conventional laparoscopic adrenalectomy. MATERIALS AND METHODS: In 12 patients clipless laparoscopic adrenalectomy was performed with needlescopic instruments in an 8-month period. The technique included 2 or 3 subcostal 2 mm. ports and 1 umbilical 5/12 mm. port for the telescope and ultimate specimen extraction. Adrenal vessels were controlled by bipolar coagulation without endoscopic clips. Outcome data were retrospectively compared with those on 20 recent conventional laparoscopic adrenalectomies done at the same institution. The 2 types of laparoscopic adrenalectomy were performed transperitoneally. RESULTS: Patients in the clipless group had a lower mean analgesic requirement (7.5 versus 15.3 mg. morphine sulfate equivalent, p = 0.02), lower mean pain and scar scores (3.1 versus 5.3 and 1.1 versus 4.2, respectively, p <0.05) and more rapid convalescence (1.6 versus 3.3 weeks, p <0.01) but longer operative time (183 versus 136 minutes, p = 0.04). Similar blood loss, time to oral intake and hospital stay were noted in the 2 groups. No major complications, open conversions or postoperative secondary bleeding occurred in either group. A 2 mm. port was converted to a 10 mm. port in only 1 case in the clipless group due to the inability to retract a bulky liver properly with a needlescopic instrument. CONCLUSIONS: Clipless laparoscopic adrenalectomy with needlescopic instruments is feasible for most benign adrenal tumors. In addition to the benefits of conventional laparoscopic surgery, clipless needlescopic laparoscopic adrenalectomy further decreased postoperative pain, shortened convalescence and improved wound cosmesis.

Adrenal Gland Neoplasms↗
PubMed2002

Hand assisted laparoscopic bilateral nephroureterectomy in 1 session without repositioning patients is facilitated by alternating inflation cuffs.

PURPOSE: Transitional cell carcinoma is common and often multifocal in patients with uremia. We report a novel approach of simultaneous laparoscopic bilateral nephroureterectomy without the need to reposition patients. MATERIALS AND METHODS: Seven patients with uremia and organ confined transitional cell carcinoma of the upper urinary tract underwent simultaneous laparoscopic bilateral nephroureterectomy. Inflatable cuffs of an air tourniquet device were placed beneath each side of the back. Alternatively inflating the cuffs and rotating the operation table facilitated position changes during surgery. The incision for the hand assisted device during laparoscopy was also used for resecting the distal ureters in an open manner. Data were compared with those on 7 patients treated with simultaneous open bilateral nephroureterectomy. RESULTS: All laparoscopic bilateral nephroureterectomies were accomplished successfully without complications except for heart failure and atlectasis in a patient with a history of myocardial ischemia. Mean blood loss (218 versus 457 ml.), parenteral narcotic requirement (25 versus 60 mg. morphine equivalent), solid food oral intake (39 versus 83 hours), postoperative hospital stay (9 versus 14 days) and convalescence to normal nonstrenuous activity (3.5 versus 5.4 weeks) were superior in the laparoscopic bilateral nephroureterectomy group. Mean operative time was about 5 hours in each group. CONCLUSION: Our data show that laparoscopic bilateral nephroureterectomy facilitated by inflatable cuffs can be performed at 1 stage with a clear operative field and no repositioning problems.

Adult↗
PubMed2002

Technical considerations in hand-assisted laparoscopic live donor nephrectomy: initial Taiwan experience from National Taiwan University Hospital.

This report describes the initial experience of laparoscopic live donor nephrectomy (lap-LDN) in Taiwan and discusses the technical considerations and modifications of our technique. From September to November 2000, three (one right and two left) lap-LDNs were performed at our institute. The right kidney was retrieved in one donor because of an early branching of the left renal artery. The details of our technique are described for both left and right LDN. The perioperative parameters were compared to those of the 10 immediately preceding cases of LDNs using the traditional open approach. All lap-LDNs and open LDNs were successful, and all 13 recipients had smooth recovery of renal function. The donors recuperated better in the lap-LDN group with resumption of oral intake on postoperative day (POD) 1 and discharge on POD 5 (vs POD 3.4 and 8.5, respectively, in the open group). The mean blood loss was lower and narcotic use was less in the lap-LDN group (75 vs 164 mL, 25 vs 47 mg morphine sulfate equivalent, respectively). The extraction wound was much shorter in the lap-LDN group (6.5-8 vs 23 cm). The warm ischemia time was slightly but not significantly shorter in the open group (4 vs 2.75 min), and the average operative time was shorter in the open group. The results of our initial experience suggest that for surgeons with laparoscopic surgery experience, lap-LDN is a feasible procedure that decreases donor discomfort, while improving the quality of graft kidneys and the safety of the donor.

Humans↗
PubMed2002

Potential pool of non-heart-beating kidney donors in Taiwan: chart review in a regional hospital.

The annual number of renal transplantations performed in Taiwan is strictly limited by the availability of donor organs. One way to expand the donor pool is the use of non-heart-beating (NHB) donors. This study evaluated the potential number of NHB kidney-donors in Taiwan using a retrospective death chart review from a regional hospital in patients who died between January 1 and December 31, 1999. Exclusion criteria were extremities of age, systemic infection, malignancies other than primary brain tumor, uncontrolled diabetes mellitus, hypertension, kidney disease, or deaths with incomplete records. Detailed biomedical data of potential donors were collected. Of the 840 in-hospital deaths, 258 were in patients aged 3 to 65 years. Among these patients, 52 (6%) did not meet any exclusion criteria and were classified as potential kidney donors. Of these 52 patients, eight (1%) were classified as very suitable donors, defined as no diabetes mellitus, no hypertension, good renal function (serum creatinine < 1.3 mg/dL), age less than 50 years, and death in the intensive care unit or emergency service. Twenty-five of the remaining 44 sub-optimal potential donors who did not meet the criteria of very suitable were classified as having high potential to be donors by a combined scoring system (sum score = 5-6). The results suggest that there is a considerable number of potential NHB kidney-donors in Taiwan. Programs to advocate use of NHB kidney donors and education of the public and transplant professionals might significantly increase the number of kidneys available for transplantation in Taiwan.

Adolescent↗
PubMed2001

De novo demonstration and co-localization of free-radical production and apoptosis formation in rat kidney subjected to ischemia/reperfusion.

Ischemia-induced oxidative damage to the reperfused kidney was examined. A modified chemiluminescence method, an in situ nitro blue tetrazolium perfusion technique, and a DNA fragmentation/apoptosis-related protein assay were adapted for demonstration de novo and co-localization of reactive oxygen species (ROS) production and apoptosis formation in rat kidneys subjected to ischemia/reperfusion injury. The results showed that prolonged ischemia potentiated proapoptotic mechanisms, including increases in the Bax/Bcl-2 ratio, CPP32 expression, and poly-(ADP-ribose)-polymerase fragments, and subsequently resulted in severe apoptosis, including increases in DNA fragmentation and apoptotic cell number in renal proximal tubules (PT) and distal tubules (DT) in a time-dependent manner. The increased level of ROS detected on the renal surface was correlated with that in blood and was intensified by a prolonged interval of ischemia. The main source of ROS synthesis was the PT epithelial cells. The ROS and apoptotic nuclei detected in the PT cells can be ameliorated by superoxide dismutase (SOD) treatment before reperfusion. However, the apoptotic nuclei remained in DT in the SOD-treated rats, indicating that formation of apoptosis in DT was not influenced by the small amounts of ROS produced. In PT and DT cell cultures, significant increases in apoptotic cells and ROS were evident in PT cells after hypoxia/reoxygenation insult. Furthermore, the oxidative damage in PT, but not in DT, can be alleviated by ROS scavengers SOD and hexa(sulfobutyl)fullerene, confirming that PT are vulnerable to ROS. These results lead us to conclude that ROS produced in significant amounts in PT epithelium under ischemia/reperfusion or hypoxia/reoxygenation conditions may be responsible for the apoptotic death of these cells.

Animals↗
PubMedDate not supplied

Clipless needlescopic bilateral varix ligation.

We report a novel technique of clipless needlescopic bilateral varix ligation and compare its results with the conventional laparoscopic approach. The positions of ports and surgical procedures were similar to those of the conventional 3-port laparoscopic technique, but all 5- and 10-mm trocars were replaced by 2-mm trocars. The internal spermatic veins proximal to the internal inguinal ring were isolated and coagulated for an adequate segment with a 2-mm bipolar electrocautery apparatus and then transected. The perioperative parameters of 25 patients operated on in this manner were compared with a historical cohort of 25 patients operated on using the conventional laparoscopic approach. Both groups of patients had uneventful surgery with no complications. The mean amount of analgesics used (1.25 vs 3.68 mg of morphine sulfate equivalent, P=.03), the maximal and mean postoperative pain scores (3.5 vs 5.6 and 2.5 vs 4.0, respectively, both P <.05), the postoperative hospital stay (0.5 vs 1.1 days, P=.03), and convalescence to normal activity (0.56 +/- 0.3 vs 1.64 +/- 0.4 weeks, P=.01) were all significantly decreased in the needlescopic group. We conclude that needlescopic bilateral varix ligation not only is feasible and safe but also provides the same therapeutic efficacy of a conventional laparoscopic approach; most importantly, it causes less pain and yields faster convalescence and excellent cosmetic results.

Adult↗
PubMedDate not supplied

Radiotherapy of classic Kaposi's sarcoma in Taiwan, an area where classic Kaposi's sarcoma is not prevalent.

BACKGROUND: Classic Kaposi's sarcoma (KS), a neoplastic disease of vascular endothelial cells of the skin, is relatively prevalent in Eastern Europe and the Mediterranean region and radiation is one of the standard therapies. The clinical presentation and treatment results of classic KS from other regions have rarely been reported. PATIENTS AND METHODS: Between 1994 and 2006, patients who had histologically confirmed KS and no immunodeficiency status due to human immunodeficiency virus infection or organ transplantation, and were treated with radiotherapy at Department of Oncology, National Taiwan University Hospital, Japan, were reviewed. RESULTS: A total of 17 classic KS patients, with a median age of 69 years, were studied over a period of 12 years. All classic KS lesions involved lower extremities. Radiotherapy was delivered with either a 60Co unit or a linear accelerator, with the most commonly prescribed treatment being 3 Gy per fraction to a total dose of 39 Gy. In addition, several techniques using bolus were adopted to improve the radiation distribution over the skin of lower extremities. All irradiated KS lesions responded, with a complete response rate of 76%. The overall survival and progression-free survival rates of the group at 5 years were 85% and 58%, respectively. CONCLUSION: Radiation therapy for classic KS patients in a non-prevalent area, such as Taiwan, is safe and effective.

Aged↗