The effective dose assessment of C-arm CT in hepatic arterial embolisation therapy.

OBJECTIVE: To assess the effective dose of the liver C-arm computed tomography (CT) scan during hepatic arterial embolisation surgery with clinical dose-area product (DAP) data from Taiwan. METHODS: The experiment used two kinds of phantoms: RANDO® Man and RANDO Woman (The Phantom Laboratory, Salem, NY), embedded with thermoluminescent dosemeters at locations according to the International Commission on Radiological Protection 103 report. The conversion factors of DAP to effective doses for males and females, respectively, were obtained. The clinical DAP data of liver C-arm CT scan during hepatic arterial embolisation surgery were collected in a hospital in Taiwan. RESULTS: There were 125 liver transarterial embolisation therapy cases, including 94 males and 31 females, from February 2009 to June 2010. C-arm CT was used 38 times for males and 17 times for females. The corresponding average and standard deviation of clinical DAP were 61.0±6.6 Gy cm(2) and 52.2±8.3 Gy cm(2), respectively. CONCLUSION: The DAP of RANDO Man and RANDO Woman phantoms simply scanned by C-arm CT are much lower than that of patients. After consideration of the clinical DAP of patients, the effective doses of a liver C-arm CT scan recommended for males and females in Taiwan are 11.5±2.3 mSv and 11.3±3.0 mSv, respectively. ADVANCES IN KNOWLEDGE: The conversion factors of DAP to effective doses for males and females are 0.19±0.03 mSv Gy(-1) cm(-2) and 0.22±0.05 mSv Gy(-1) cm(-2). Only if the actual DAP value of a patient scan is multiplied by the conversion factor can the correct effective dose be determined.

Negative regulation of the Wnt-beta-catenin pathway by the transcriptional repressor HBP1.

In certain cancers, constitutive Wnt signaling results from mutation in one or more pathway components. The result is the accumulation and nuclear localization of beta-catenin, which interacts with the lymphoid enhancer factor-1 (LEF)/T-cell factor (TCF) family of HMG-box transcription factors, which activate important growth regulatory genes, including cyclin D1 and c-myc. As exemplified by APC and axin, the negative regulation of beta-catenin is important for tumor suppression. Another potential mode of negative regulation is transcriptional repression of cyclin D1 and other Wnt target genes. In mammals, the transcriptional repressors in the Wnt pathway are not well defined. We have previously identified HBP1 as an HMG-box repressor and a cell cycle inhibitor. Here, we show that HBP1 is a repressor of the cyclin D1 gene and inhibits the Wnt signaling pathway. The inhibition of Wnt signaling and growth requires a common domain of HBP1. The apparent mechanism is an inhibition of TCF/LEF DNA binding through a physical interaction with HBP1. These data suggest that the suppression of Wnt signaling by HBP1 may be a mechanism to prevent inappropriate proliferation.

Patient-controlled analgesia with morphine plus lysine acetyl salicylate.

UNLABELLED: Using a patient-controlled analgesia (PCA) delivery system, we evaluated the clinical advantages and disadvantages of morphine PCA compared with morphine plus lysine acetyl salicylate (LAS), a soluble aspirin. After major orthopedic surgery, 50 adult patients were enrolled in a prospective, randomized, and double-blinded study. When a patient in the recovery room complained of pain, an initial dose of morphine or the morphine/LAS mixture was titrated to achieve analgesia of visual analog score < or = 3 in 30 min. An equivalent volume PCA dose of either morphine 1 mg/mL or morphine 0.5 mg + LAS 90 mg/mL was used with a lockout interval of 10 min. Pain score, patient satisfaction, vital signs, and adverse effects were observed for 48 h. Adequate analgesia (visual analog scale score < or = 3) was achieved with either drug. Morphine consumption in the morphine/LAS group was significantly less than in morphine group (13.9 vs 18.4 mg in 24 h and 24.3 vs 32.4 mg in 48 h). Significantly more sedation was evident with the morphine group (P < 0.05). We conclude that injectable LAS can be used as an effective and safe adjuvant to morphine for PCA. This combination reduces dose requirements of morphine and hence some of its adverse effects. IMPLICATIONS: Injectable aspirin could be used as an effective and safe adjuvant to morphine for patient-controlled analgesia. This combination reduces the dose requirement of morphine and therefore some of the morphine-related untoward effects.

Glomus tumors of the upper extremity: experience with twelve cases.

BACKGROUND: The glomus tumor is an uncommon tumor of the hand, which presents with much pain. It is a benign neoplasm composed of a glomus body, which is located in the dermis. Glomus tumors present a classic clinical picture of pain, sensitivity to cold and local tenderness over the lesion. METHODS: Twelve patients underwent surgical removal for glomus tumors of the upper extremity from 1983 to 1992. There were three males and nine females; their average age was 37 years (25 to 60 years). The clinical manifestations were pain and local tenderness in 12 patients, and cold intolerance in 6 patients. RESULTS: There was a difference in gender in the anatomical site of the tumor. In three male patients, only one tumor was found in the digit. In female patients, all nine tumors were located in the digits. The average tumor size was 0.6 cm in diameter. After follow-up of 4.5 years (average), no recurrence, no residual pain or cold intolerance was noted. CONCLUSIONS: The treatment of glomus tumor consisted of local excision or curettage, with or without reconstruction of the nail bed. Recurrence is not a problem after complete removal of the tumor tissue. Permanent nail deformity is still a problem. Efforts to prevent this sequelae are worth trying.

Pigmented villonodular synovitis.

Seventy-three patients, 28 males and 45 females, diagnosed with pigmented villonodular synovitis (PVNS) between 1982 and 1990 were followed for an average of 42.2 months (range, 21 to 108 months). Fifty-five cases occurred in the tendon sheath and eighteen in synovial joint. Ages ranged from 5 to 77 years, with an average of 38.9 years. The clinical presentations included chronic tumescence, serosanguinous arthrocentesis and painful limitation of range of motion. Plain roentgenography usually demonstrated soft tissue swelling with varying density, bony erosion or joint space narrowing. Arthrography and magnetic resonance imaging both gave specific pictures, with good diagnostic rates. The therapeutic regimen consisted of marginal excision for tendon sheath lesions and total synovectomy for intraarticular lesions. Extensive synovectomy with prosthesis replacement yielded good functional results in elderly patients with PVNS and cartilage destruction. Recurrence rate averaged 26% and was higher among knee joint lesions (33%), possibly because of inaccessibility of the popliteal fossa and inadequate excision of the lesion. Differences in the mitotic index between recurrence and non-recurrence groups had no statistical significance. This phenomenon may well serve against "tumor origin" as the etiology of this disease.

[Treatment of proximal humeral tumor: a case report].

In management of malignancy of the proximal humerus, amputation or a complete flail limb both give poor functional results. The limb-salvage procedure with joint reconstruction preserves function in the elbow and hand, thereby improving the quality of remaining life for patient. Prosthetic humeral replacement may avert amputation and preserve a functional arm, but neither segmental modular proximal humeral prosthesis nor custom-made prosthesis is readily available here. Combining the Neer II shoulder prosthesis and Kuntscher's nail with acrylic cement can replace the proximal humerus with an adjustable length of stem within the humeral shaft. A piece of mesh is incorporated into the prosthesis, placed around the neck of the Neer II shoulder prosthesis, and sutured to the rotator cuff to prevent subluxation of the humeral head and preserve some function of the rotator cuff. The above prosthetic humeral replacement has been applied to one patient with a primary osteosarcoma. It preserved the function of the elbow and hand well. One year post-operatively, there was no dislocation or subluxation. Details of procedures used are given.

[Primary amyloidoma of the spine].

Amyloidosis involving the musculoskeletal system is an uncommon occurrence. The primary form is rare and only six cases involving the spine have been reported in the literature. The following case is believed to be the first reported in Taiwan. A 65-year-old male was admitted due to chronic nonspecific pain in the lower back with progressive paralysis of the lower limbs. Amyloidoma involving both thoracic and lumbar spine, never reported in the literature, was proved by histologic and histochemical studies. Serial radiographic examinations were also presented. Anterior decompression of the thoracic spine with iliac crest strut bone graft and Kaneda device fixation achieved good functional results. The symptoms and signs of spinal amyloidoma are nonspecific and difficult to diagnose; hence a correct diagnosis requires the surgeon to be extremely suspicious. A special histochemical stain is essential for this purpose. Because of the rarity, we report this case with review of the literature.