Colorectal anastomosis after laparoscopic extended left colectomy: techniques and outcome.

AIM: After extended left colectomy, traditional colorectal anastomosis is often not feasible because of insufficient length of the remaining colon to perform a tension-free anastomosis. Total colectomy with ileorectal anastomosis could be an alternative but this can lead to unsatisfactory quality of life. Trans-mesenteric colorectal anastomosis or inverted right colonic transposition (the so-called Deloyers procedure) are two possible solutions for creating a tension-free colorectal anastomosis after extended left colectomy. Few studies have reported their results of these two techniques and mostly via laparotomy. The aim of this study was to describe the trans-mesenteric colorectal anastomosis and the inverted right colonic transposition procedure via a laparoscopic approach and report the outcome in a series of 13 consecutive patients. METHOD: This was retrospective chart review of laparoscopic colorectal surgery with trans-mesenteric colorectal anastomosis or the inverted right colonic transposition procedure from January 2015 up to 2019. An accompanying video demonstrates these two techniques. RESULTS: Thirteen consecutive patients underwent either a laparoscopic trans-mesenteric colorectal anastomosis (n = 9) or an inverted right colonic transposition procedure (n = 4). One patient had intra-operative presacral bleeding that was stopped successfully without conversion. Two patients had a postoperative intra-abdominal abscess, but no anastomotic complications were recorded. The median number of bowel movements per day after 6 months was 2 (range 2-5). CONCLUSIONS: Trans-mesenteric colorectal anastomosis or the inverted right colonic transposition procedure is feasible laparoscopically. The now well-established classical advantages of the laparoscopic approach are associated with good functional outcome after these procedures.

Overview of diagnosis and management of metastatic disease to bone.

BACKGROUND: Bone metastases occur frequently in patients with advanced cancer and are a serious complication of cancer. The decision to treat is often individualized, based on each patient's clinical presentation, life expectancy, and quality of life. METHODS: We reviewed the current literature pertaining to management of metastatic disease to bone, and the medical, radiotherapeutic, and surgical treatment options for management of bone metastasis are discussed. RESULTS: Current management of skeletal metastasis includes analgesia, systemic therapy, radiation therapy, and surgery. We propose treatment algorithms for management of vertebral and nonvertebral bone metastases and suggest individualized interventions based on clinical presentation. CONCLUSIONS: Management of bone metastases is complex and requires a multidisciplinary approach. The goal of treatment is often palliative, and intervention and treatment regimens should be individualized based on the specific clinical presentation of each patient.

Evaluation of transforming growth factor and vascular endothelial growth factor polymorphisms in Taiwan Chinese patients with pterygium.

PURPOSE: Pterygium is an invasive and highly vascularized growth, thought to arise from activated and proliferating limbal epithelial stem cells. Epidemiologic studies have found the increase of active angiogenic and epithelial growth factors in pterygia, and implicated that these molecules could be involved directly or indirectly in the pathogenesis of pterygia as causative factors. The aim of this study was to investigate the association of polymorphisms of transforming growth factor (TGF) and vascular endothelial growth factor (VEGF) with pterygium. METHODS: A total of 133 pterygium patients and 105 volunteers without pterygium were enrolled in this study. Polymerase chain reaction based restriction fragment length polymorphism analysis was used to resolve the TGF-Beta1-509 and VEGF-460 genotypes. RESULTS: There was no significant difference in the allele frequency or genotype of TGF-Beta1-509 or VEGF-460 between total pterygium and the control group. No interaction between TGF-Beta1-509 and VEGF-460 was found either. CONCLUSIONS: These results indicate that TGF-Beta1-509 and VEGF-460 polymorphisms were not highly associated with the pathology of pterygium. However, it may still be worthwhile to continue to search for angiogenic gene polymorphisms in order to predict the development of pterygium.

Are marketing campaigns in Taiwan by foreign tobacco companies targeting young smokers?

OBJECTIVE: To assess the impact of promotions on cigarette sales in Taiwan after the cigarette market opened to foreign companies, and to assess whether young smokers were targeted by these companies. METHODS: Trends in cigarette sales, advertising expenditure, brand preference, and cigarette consumption were examined for the period following the 1987 opening of the cigarette market. Tobacco industry internal documents from Legacy Tobacco Documents Library of the University of California, San Francisco, were searched for corporate strategies on promoting youth consumption in Taiwan. RESULTS: Between 1995 and 2000, the inflation adjusted advertising expenditures by all foreign firms increased fourfold. Much of the expenditure was spent on brand stretching the Mild Seven (Japan) and Davidoff (Germany) brands in television advertising. By 2000, the market share of foreign cigarettes exceeded domestics by three to one among young smokers and the leading brand preferred by this segment shifted from the most popular domestic brand (Long Life) to a foreign brand (Mild Seven). Furthermore, there was a sudden increase of 16.4% in smoking rates among young adults (from 36.1% to 42.0%) during the first five years after the market opened. This was also accompanied by increased per capita cigarette consumption and decreased age of smoking initiation. Industry documents confirmed the use of strategies targeted at the young. In particular, establishing new point of sale (POS) retail stores or promotional activities at POS were found to be more effective than advertising in magazines. CONCLUSIONS: This study provides evidence that advertising increased with increased competition following the market opening, which, in turn, spurred cigarette sales and consumption. Foreign tobacco companies have deliberately targeted youth in Taiwan and succeeded in gaining three quarters of their cigarette purchases within a decade. Expanding youth consumption will incur excessive future health care costs borne by society. Foreign tobacco companies should be obligated to reimburse these expenses through higher tariffs on cigarettes.

The relationship of aging to endotoxin shock and to production of TNF-alpha.

BACKGROUND: Aged people are considered prone to gram-negative bacteremia and septic shock. This relationship was tested in murine endotoxin shock. METHODS: Balb/c mice of various ages (1.4-13.4 months) were intraperitoneally injected with lipopolysaccharide (LPS), and rates of survival were observed. The production of TNF-alpha in vivo induced by LPS was measured. RESULTS: The survival rates were the smallest in the oldest and youngest groups. Production of TNF-alpha attained a maximum at 2 h after LPS injection and was smaller in the oldest group; it had a reciprocal relationship to survival rates in each group except the youngest group. CONCLUSION: Old and young mice had smaller rates of survival and greater production of TNF-alpha following endotoxin shock induced by LPS.

Induction of apoptosis by esculetin in human leukemia cells.

Esculetin, a coumarin compound, has been shown to exhibit antioxidant and anti-inflammatory effects. In the present study, esculetin was found to inhibit the survival of human promyelocytic leukemia HL-60 cells in a concentration-dependent and time-dependent manner. HL-60 cells underwent internucleosomal DNA fragmentation and morphological changes characteristic of apoptosis after a 24-h treatment with esculetin (100 microM). Flow cytometric analysis showed that the hypodiploid nuclei of HL-60 cells were increased to 40.93% after a 36-h treatment with esculetin (100 microM). Further investigation showed that esculetin induced the release of cytochrome c from mitochondria into cytosol in a time-dependent and concentration-dependent manner. Moreover, esculetin application reduced Bcl-2 protein expression to 58% after 9 h as compared with that time at 0. Cysteine protease 32 kDa proenzyme (CPP32), a caspase 3, was activated and its substrate, poly (adenosine diphosphate-ribose) polymerase, was cleaved after a 24-h treatment of HL-60 cells with esculetin. These data suggest that esculetin induces apoptosis in human leukemia cells by increasing cytosolic translocation of cytochrome c and activation of CPP32.

Transscleral fixation of foldable intraocular lens after pars plana lensectomy in eyes with a subluxated lens.

Two patients had a subluxated crystalline lens: one with Marfan's syndrome and the other with traumatic cataract. A pars plana lensectomy with transscleral fixation of a foldable silicone intraocular lens rather than a conventional poly(methyl methacrylate) lens was performed. Excellent, rapid visual rehabilitation was obtained using this small incision technique.

Color vision after laser in situ keratomileusis.

PURPOSE: To evaluate the effect of laser in situ keratomileusis (LASIK) on color vision. SETTING: Department of Ophthalmology, China Medical College Hospital, Taichung, Taiwan. METHOD: This prospective study comprised consecutive patients having LASIK. Patients were eligible for inclusion if they had a best corrected visual acuity of 20/20 or better and a normal color vision test preoperatively and an uncorrected near visual acuity of 20/40 or better postoperatively. Color vision was tested using the Farnsworth-Munsell 100-hue test (FM 100 test) preoperatively and 1 day, 1 week, and 1 month postoperatively. RESULTS: Twenty-nine eyes of 15 patients having LASIK were enrolled in the study. The mean patient age was 29.2 years +/- 2.9 (SD). The mean preoperative spherical equivalent refractive error was -5.6 +/- 1.8 diopters, and the mean preoperative error score of the FM 100 test was 3.79 +/- 1.55. After surgery, no significant change in the error score was observed at 1 day (4.30 +/- 1.07, P =.1039, paired t test), 1 week (3.72 +/- 1.25, P =.8125, paired t test), or 1 month (3.97 +/- 1.29, P =.6149, paired t test). CONCLUSION: Laser in situ keratomileusis did not affect color vision evaluated by the FM 100 test.

Natural history of central islands after laser in situ keratomileusis.

PURPOSE: To assess the incidence and natural history of central islands following laser in situ keratomileusis (LASIK) and evaluate the association of central island characteristics with visual acuity. SETTING: Department of Ophthalmology, China Medical College Hospital, Taichung, Taiwan. METHODS: A consecutive series of 406 eyes of 212 patients who had LASIK was retrospectively evaluated. Uncorrected visual acuity (UCVA) was measured and corneal topography performed preoperatively and 1 week and 1, 3, 6, and 9 months postoperatively. Best spectacle-corrected visual acuity (BSCVA) was evaluated preoperatively and 1, 3, and 6 months postoperatively. RESULTS: The topographic images obtained at 1 week demonstrated central islands in 23 eyes of 20 patients (5.7%). No new cases of central island formation were identified after 1 week. Of the 23 eyes with central islands, the 6 month post-LASIK maps were available in 20 eyes of 18 patients. There was a significant difference in the size and power of the central islands between 1 week and 6 months. However, the power and size decreased slowly. Within 6 months, only 5 of 20 central islands (25.0%) had resolved. Eight eyes were undercorrected, and 1 eye lost 2 lines of BSCVA. Central islands larger than 1.8 mm or 3.0 diopters (D) were significantly correlated with lower UCVA. CONCLUSION: Most central islands that occur with LASIK persist more than 6 months. Large central islands (>/=1.8 mm or >/=3.0 D) are risk factors for lower UCVA. Preventive measures are necessary.

Ablation centration after active eye-tracker-assisted photorefractive keratectomy and laser in situ keratomileusis.

PURPOSE: To evaluate the ablation centration after active eye-tracker-assisted photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) and to investigate the effect of surgery, patient, and surgeon on the centration. SETTING: Department of Ophthalmology, China Medical College Hospital, Taichung, Taiwan, Republic of China. METHODS: This retrospective study comprised 177 eyes of 101 patients: 16 eyes had PRK and 161, LASIK. All laser treatments were performed with the aid of an eye tracker. The amount of decentration was analyzed by corneal topography. The factors influencing centration were divided into surgery related (PRK/LASIK), patient related (low/high myopia and effect of learning), and surgeon related (learning curve). RESULTS: The mean decentration was 0.33 mm in PRK eyes and 0.35 mm in LASIK eyes. For the surgery-related factor, there was no significant difference between the PRK and LASIK eyes. For the patient-related factors, centration was better in the second eye (effect of learning) and decentration was more severe in eyes with high myopia (low/high myopia). For the surgeon-related factor, there was no significant difference between eyes that had the first 50 LASIK procedures and those that had the last 50 procedures. CONCLUSIONS: An eye tracker, which makes the laser beam follow the eye's movements, helps to avoid severe decentration. This study showed, however, that an active eye-tracking system alone cannot ensure good centration. Patient cooperation and fixation are important.

Microdialysis of salicylic acid from viscous emulsion samples prior to high-performance liquid chromatographic determination.

A micro-dialysis method was developed to isolate aqueous salicylic acid from viscous emulsion samples prior to HPLC determination. The optimal conditions for obtaining dialysis efficiency of salicylic acid as well as chromatographic conditions were investigated. Experimental results indicated that the dialysis achieved at pH 2.0 (0.025 M phosphate solution), 0.5 M NaCl addition, and 50-microl/min flow-rate of perfusion stream offered an optimal result. The proposed method provided a simple procedure for isolating salicylic acid from viscous emulsion samples. Application was illustrated by the analysis of salicylic acid in cosmetic products.

Reiter's syndrome caused by Streptococcus viridans in a patient with HLA-B27 antigen.

A 26-year-old male patient with mitral valve prolapse and HLA-B27 antigen received endodontic treatment for dental caries. Two weeks later fever, dysuria, diarrhea, sterile inflammatory arthritis of lower limbs, enthesitis, dactylitis, conjunctivitis, and uveitis consecutively developed. Blood culture performed at the time of active arthritis yielded Streptococcus viridans. He did not have any history of psoriasis, acute infectious diarrhea, chronic inflammatory bowel diseases, or sexually transmitted diseases. Laboratory studies also excluded the possibility of infections by human immunodeficiency virus, hepatitis B or C virus, chlamydia, and streptococci from the upper airway. This report indicates that Streptococcus viridans can be the triggering microorganisms of Reiter's syndrome in some circumstances.

The reactivity of sera from patients with systemic lupus erythematosus to seven different species of single and double stranded deoxyribonucleic acids.

OBJECTIVE: Anti-DNA antibodies are frequently found in the serum of patients with systemic lupus erythematosus (SLE). To understand whether the avidity of SLE sera to different species of single-stranded (ss) and double-stranded (ds) DNA is different or not, the reactivity of active SLE sera to seven species of DNA from viral, bacterial, piscine, and mammalian sources was compared. METHODS: Nineteen sera from patients with active SLE were studied for their reactivity to different ssDNA and dsDNA from Escherichia coli (EC), Micrococcus lysodeikticus (ML), Clostridium perfringens (CP), calf thymus (CT), salmon testis (ST), human placenta (HP) and lambda phage by ELISA. The dsDNA was purified by treating it with S1 nuclease and proteinase K, followed by Sephacryl S-300 gel filtration. The ssDNA was purified by absorption on a hydroxyapatite column after heat-cleavage of the dsDNA. RESULTS: The reactivity of SLE sera to 7 species of dsDNA was not significantly different and they recognized a more widely shared epitope. In contrast, the reactivity of these sera to 7 species of ssDNA was erratic and the antigens could be grouped into high (CP and HP), medium (EC, ML, CT, and ST) and low (lambda-phage) antigenicities. CONCLUSION: The anti-ssDNA and anti-dsDNA antibodies of SLE patients recognize more widely shared determinants on the DNA of seven different species. Lambda-phage DNA shows the poorest immunogenicity among them.

Decreased spontaneous and lipopolysaccharide stimulated production of interleukin 8 by polymorphonuclear neutrophils of patients with active systemic lupus erythematosus.

OBJECTIVE: Interleukin 8 (IL-8) acts as a potent chemotactic cytokine and also as an autocrine factor for polymorphonuclear neutrophils (PMN), thus amplifying the acute inflammatory reaction. We undertook to study the IL-8 producing capacity of PMN in patients with systemic lupus erythematosus (SLE). METHODS: PMN from twelve patients with active SLE, from fifteen patients with inactive disease and from sixteen healthy individuals were incubated for 24 hours in medium alone, or in medium with lipopolysaccharide (LPS) or TNF-alpha. The IL-8 concentration in the culture supernatants was measured by an enzyme linked immunosorbent assay. RESULTS: We found that the spontaneous and LPS-stimulated, but not TNF-alpha-stimulated, production of IL-8 by the PMN of active SLE patients were significantly lower than that of healthy individuals. The impaired IL-8 production by SLE-PMN was linked to disease activity but not to the administration of steroid, because incubation of normal PMN or inactive SLE-PMN with prednisolone (1 microgram/ml and 5 micrograms/ml) for 24 hours did not affect IL-8 production. In addition, IL-8 production increased in three active SLE patients after effective treatment with immunosuppressants but not in two cases of ineffective treatment, in the follow-up study. CONCLUSION: These results suggest that decreased IL-8 production is one of the defects of PMN in patients with active SLE, which might predispose SLE patients to infection.

Successful treatment of recurrent corneal intraepithelial neoplasia with topical mitomycin C.

PURPOSE: To evaluate the clinical efficacy of topical mitomycin C (MMC) 0.04% in the treatment of recurrent corneal intraepithelial neoplasia. METHODS: A 71-year-old man presented with a limbal tumor that had extended onto the inferior temporal quadrant of the left cornea. Superficial lamellar sclerokeratectomy was performed to remove the tumor, which was histopathologically demonstrated to be a corneal intraepithelial neoplasia. Fifteen months after the surgical excision, the tumor recurred at the previous keratectomy site. The patient was treated topically with 0.04% MMC four times daily for 2 weeks, during which time he only had a mild degree of conjunctival hyperemia and ocular pain. RESULTS: The tumor resolved completely after 2 weeks of treatment and did not recur during the 10-month follow-up. CONCLUSION: Topical MMC may be an effective alternative treatment for recurrent corneal intraepithelial neoplasia and deserves further evaluation.

Total morphine stability in urine specimens stored under various conditions.

The stability of total morphine in urine stored under various conditions was studied using control and experimental specimens. Samples in the control group were prepared using drug-free urine spiked with morphine at three concentration levels (300, 1000, and 2500 ng/mL), each with the pH adjusted to 5.5, 6.5, and 7.5. Samples in the experimental group came from 20 alleged heroin addicts (provided by Taipei Municipal Psychiatric Hospital). Samples in both groups were divided into two categories--one with and one without the precipitate (formed at 0 degrees C) removed. Samples in each of these two categories were further divided into two sub-groups--one with and one without sodium azide (0.05%) added. Total morphine contents in these samples were first determined by gas chromatography-mass spectrometry prior to storage and at 6, 12, 18, and 24 months following storage at -20, 4, 25, and 35 degrees C. Effects of sample treatment (azide addition and precipitate removal), pH, and storage temperature and length were evaluated by examining the percentage of total morphine remaining at the four time intervals following the initial determination. Major findings were as follows: (1) total morphine decomposition was minimal when stored for 12 months at -20 degrees C, which is a common current practice; (2) samples with lower initial sample pH had slower total morphine decomposition rates; and (3) azide addition appeared to have no detectable effect, whereas precipitate removal appeared to marginally reduce the decomposition rate, especially for samples with lower pH.

A double-blind, randomized, controlled parallel group study evaluating the efficacy and safety of acemetacin for the management of osteoarthritis.

The aim of the present study was to compare the efficacy and tolerability of a new form of nonsteroidal antiinflammatory drug (NSAID), acematacin (Acemet), with indomethacin, in patients suffering from osteoarthritis (OA). Patients diagnosed with OA were included in a double-blind, randomized, controlled parallel group study A total of 42 patients were randomized to either acemetacin 60 mg t.i.d. or indomethacin 25 mg t.i.d. for 28 days. At an outpatient clinic, each patient was followed up regularly for efficacy, compliance and possible adverse events. Both drugs produced a statistically significant improvement for primary efficacy variables: change of pain score during motion and restriction of body movement. Values for overall tolerability and incidence of gastrointestinal side effects were significantly lower for acemetacin than for indomethacin. We therefore suggest that acemetacin, by demonstrating significant tolerability and safety advantages, is as effective as indomethacin for the treatment of OA.

Pediatric endogenous endophthalmitis.

Pediatric endogenous endophthalmitis is a rare disease that can cause serious ophthalmic damage. We describe two cases of pediatric endogenous endophthalmitis. The first occurred in an 8-month-old boy and the second in a 7-day-old girl. These two patients had developed pneumonia due to Pseudomonas aeruginosa infection prior to the onset of ocular symptoms. The interval between the onset of pneumonia and ocular symptoms was 1 week, but endophthalmitis was diagnosed 9 days after the onset of ocular symptoms in the first case and 3 days after the onset of ocular symptoms in the second case. The ocular manifestations included eyelid swelling, purulent discharge, redness, corneal edema, hypopyon, and poor red reflex. Despite treatment with aggressive antimicrobial therapy, both patients became totally blind with eyeball atrophy.

Risk factors in endophthalmitis leading to evisceration or enucleation.

BACKGROUND AND OBJECTIVE: This study aimed to evaluate the risk factors associated with evisceration or enucleation in endophthalmitis cases. PATIENTS AND METHODS: A retrospective analysis was conducted of all cases of endophthalmitis in a single unit over a 10-year period. The cases were divided into two groups. The group 1 consisted of patients with endophthalmitis who underwent evisceration or enucleation. The group 2 included patients with endophthalmitis who recovered with intravitreal injection or vitrectomy. RESULTS: During the 10-year study period, 86 patients with endophthalmitis were admitted for treatment. Evisceration or enucleation was undergone by 20 patients (23.2%) (Group 1); Group 2 consisted of 66 patients. Older age (P = 0.03), no light perception at presentation (P < 0.0001), endophthalmitis associated with corneal ulcer (P < 0.0001), and endogenous endophthalmitis (P = 0.048) were statistically significant factors associated with the need for evisceration or enucleation.

Giant tear retinal detachment after laser in situ keratomileusis--a case report.

A 42-year-old woman with a refractive error of -10.00S - 2.00C x 105 degrees in the right eye underwent laser in situ keratomileusis (LASIK) at our hospital. LASIK was performed using the Schwind excimer laser (Keratom Multiscan, Schwind, Kleinostheim, Germany) and Moria LSK--One manual microkeratome with a 130 microns ablation plate. The uncorrected visual acuity improved postoperatively, and the patient was very satisfied. However, nine months later, she complained of sudden loss of visual acuity in the right eye. Indirect ophthalmoscopy revealed a giant retinal tear extending from 10:00 to 2:00 o'clock position with retinal detachment and vitreous hemorrhage. We performed scleral buckling procedure (with silicone band encircling), vitrectomy, and fluid-gas exchange with air/SF6 mixture. The retina attached postoperatively and remained so during 3-month follow-up period, but cellophane maculopathy was noted.