Background: The aim of this study was to evaluate practicable predictors of 5-year disease-free survival (DFS) and impact of 5-fluorouracil (5-FU)-based adjuvant chemotherapy in stage IIa and IIb colon cancer. Materials and Methods: A total of 1474 patients with stage II colon cancer were enrolled in study. The independent predictors of 5-year DFS and the benefits of adjuvant chemotherapy were analyzed for patients with stage IIa (n = 771) and IIb (n = 703). Results: The incidences of pretreatment anemia, hypoalbuminemia, emergent surgery, and lymphovascular invasion (LVI) corresponded significantly to an advanced T-stage in patients with stage II colon cancer. Although the incidence of surgical morbidity was not different between stage IIa and IIb, stage II patients with hypoalbuminemia had a higher incidence of surgical morbidity than did those with normal serum albumin (17.2% vs. 9.6%, P < 0.001). The co-independent survival predictors in patients with stage IIa and IIb colon cancer were carcinoembryonic antigen (CEA < 5 ng/mL, P = 0.007 and 0.043), serum albumin (≥3.5 g/dL, P < 0.001 and P = 0.025), and nonsurgical morbidity (P < 0.001, both). Suboptimal lymph node harvest (<12 examined nodes, P < 0.001) and no adjuvant chemotherapy (P = 0.008) were poor prognostic factors only in stage IIb colon cancer. LVI showed a trend to worse DFS (P = 0.059). A survival benefit from adjuvant chemotherapy analyzed in four subgroups stratified by stage IIa and IIb, with or without the present prognostic factors, was only observed in patients with stage IIb colon cancer with hypoalbuminemia, abnormal CEA, suboptimal lymph node harvest, and postoperative morbidity. Conclusion: Different predictors of DFS were observed in stage IIa and IIb colon cancer; adjuvant chemotherapy could provide a survival benefit for patients with stage IIb colon cancer who have one of the four factors that were studied in our hospital-based analysis.

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Background: Although thoracic endovascular aneurysm repair (TEVAR) has been widely used as the first choice of emergency surgical procedure for ruptured descending thoracic aortic aneurysms (rDTAAs), the risk factors of adverse outcome have less been investigated. Purpose: To investigate the outcomes of patients undergoing TEVAR for rDTAA and to identified risk factors of worse prognoses. Materials and Methods: The surgical outcome of TEVAR for rDTAA in National Cheng Kung University Hospital was retrospectively analyzed. From February 2008 to December 2016, 27 patients were included, after excluding patients with traumatic aortic injury, infected aneurysm, esophageal malignancy-related aortoesophageal fistula or those in association with aortic dissection. Results: There were 5 (18.5%) 30-day mortalities, including 3 (11.1%) intraoperative deaths. Seven additional patients died during follow-up and the estimated survival rate at 1 year and 3 years was 61.3 ± 9.7% and 50.5 ± 10.6%, respectively. Among these patients with late mortality, five patients presented with hematemesis or hemoptysis preoperatively. Aortoesophageal fistula was confirmed in three patients by esophagogastroduodenoscopy presenting with hematemesis. These patients underwent subsequent open debridement along with esophagectomy after TEVAR and remained alive during follow-up. On the other hand, those with possible occult aortic fistulations that were not detected by endoscopic examinations and not surgically managed had worse late outcomes (P = 0.058). Conclusions: For patients with rDTAA having hematemesis or hemoptysis as part of the initial presentations, careful survey for possible aorta-related fistulation is important. Although definite diagnosis of fistulation might be difficult, surgical exploration for hematoma evacuation, adequate debridement, and repair of intraoperative identified fistulation should be advocated.

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Background: Autologous fat graft is a well established technique for soft tissue augmentation and the most significant drawback remains the unpredictability of the absorption rate and the possible repeating fat harvest procedures. In our basic study, we found evidence to support that fat cryopreservation is a practical method of storing fat tissue and several anecdotal clinical experiences suggest its clinical efficacy. Methods: Thirty two patients who received autologous cryopreserved fat grafts for facial deficiencies were retrospectively reviewed. Autologous cryopreserved fat grafts were transplanted for “touch up” or augmentation of other soft tissue deficiencies at least three months after fresh fat grafting, The patients' satisfaction was evaluated by a study-specific questionnaire. Results: 84 autologous fresh fat graft and 178 autologous cryopreserved fat graft procedures for the face were performed in 32 patients. There was no infection, skin retraction, fibrosis or necrosis identified except one patient complained of lump formation in the left upper lid (1/178, 0.6%). The self-assessment questionaaire revealed no statistical difference of effectiveness rating between the fresh and cryopreserved fat grafting results (mean± standard deviation: 8.64±1.09 vs 8.73±0.985; P > 0.05) but there was significant statistical difference of convenience rating between the fresh and cryopreserved fat grafting (mean± standard deviation: 2.68±1.07 vs 8.41±1.05; P < 0.05). Of the twenty-two patients who returned the questionnaire, all reported willing to have the treatment in the future (9.73±0.456) and all said that they would like to recommend this treatment to their friends (9.82±0.395). Conclusions: Autologous cryopreserved fat graft is a safe, simple, and convenient technique to restore facial soft tissue defects with acceptable patient satisfaction rate. Clinical Question/Level of Evidence: Therapeutic, IV.

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Background: The Taiwan Surgical Association (TSA) has been in operation for more than 50 years since its establishment. We checked the data of the members recently to have a full understandings and mastery of the human resources of TSA. Materials and Methods: All the data were collected from the basic data pool of the member maintained by the TSA. The annual membership, new memberships, deaths and withdrawals, age distribution, gender, surgical subspecialty, geographic distribution, and new major surgical specialist-issued licenses were checked. Results: The results were total membership increased lineally and doubled from 3020 to 6154; new members increased 124–197 per year, death and withdrawal were 4–53 annually; highest age range was 51–60, mean age 52.99 and median age 53; ratio of male and female increased from 0.8% to 4.4%; great majority of surgical specialist was gastroenterological surgery 29%, orthopedics 14%, urology 13%, thoracic and cardiovascular surgery 13%, and plastic surgery 11%; members were higher in metropolitan, Taipei 21.7%, New Taipei City 8.2%, Taichung 14%, and Kaohsiung 14.8%; and number of surgical-related subspecialty increased recently. Conclusions: There are still a lot of areas for the TSA members to explore. The data suggest that the government officials could provide more beneficial acts to the development of surgical society in Taiwan. For example, they might be able to guide a reasonable work shift hour limit, maximal care surgical patients' number, adequate nurse practitioners, setup legal surgical assistants in the operation room, well-training sufficient surgical residents program, and balance the number for the surgical subspecialty.

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Neuroendocrine tumors are a group of heterogeneous tumors originating from peptidergic neurons and neuroendocrine cells and can occur in many organs and tissues of the body. We reported a 77-year-old woman who had undergone a left hemicolectomy for descending colon adenocarcinoma 20 years previously, postoperatively; the final disease stage was T1N0M0 (Stage I). However, neuroendocrine carcinoma (NEC) at ascending colon with liver metastasis was found in a regular colonoscopy, accidentally. There are interesting with the findings in our case where the patient had an advanced stage of NEC in the ascending colon and an early-stage adenocarcinoma in the descending at the different time. She refused any palliative therapy even though she died 8 months postoperatively. To our best knowledge, this is the first case of metachronous adenocarcinoma and large-cell NEC at the different side of the colon. We believe surmise that previous adenocarcinoma of descending colon should be included in the risk factor even if the patient stood well after the operation in the follow-up.

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Urethral calculus is a very rare cause obstructive uropathy. Incidence of urethral calculus is extremely rare, less often in females as compared to males. It is usually associated with genitourinary pathology. Primary or native urethral calculus, formed in situ in the urethra whereas secondary or migratory urethral calculi originate from the kidney or bladder and descend into urethra. Most of the primary urethral stones are formed in association with functional or anatomical pathology such as chronic stasis, urinary tract infection, urethral diverticulum, meatal stenosis, urethral stricture, periurethral abscess or fistulous tract. Diagnosis of urethral calculus is sometimes difficult due to its location, and failure of diagnosis may leads to urethral injury, urinary incontinence or renal insufficiency. We present a case of 50 years old woman with acute retention of urine. On genital examination stone was visible at the urethral meatus. On cysto-urethroscopy, no urethral abnormality was detected. On further ultrasound evaluation, no stone was visualised in the kidney or the bladder. Our case is distinct because no anatomic abnormalities were detected after complete urological evaluation.

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Hepatic artery pseudoaneurysm is a type of visceral artery aneurysm, which may cause life-threatening situation if the diagnosis and treatment are delayed after rupture. Increased clinical awareness and aggressive, definitive management are necessary in obtaining optimal outcomes. In general, surgery is the preferred treatment for extrahepatic lesions, whereas embolization is appropriate for intrahepatic aneurysms. However, exploratory laparotomy for vascular ligation or anastomosis is the only way in emergency if the hemodynamic status is unstable. Since the cases of ruptured pseudoaneurysm in both intra- and extra-hepatic artery is rare, we present a case of ruptured hepatic artery pseudoaneurysms with hemorrhagic shock rescued by surgery to stabilize the patient, followed by angioembolization to manage the multiple hepatic aneurysms and provide a review of the current literature on this topic, focusing on appropriate decision-making under multidisciplinary management.

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Abdominoscrotal hydrocele (ASH) is a rare cause of cystic abdominal and scrotal mass in children. A timely diagnosis is important because appropriate surgical treatment is important. We encountered a patient who presented with scrotal swelling and later turned out to be a patient of ASH. The case is being presented with review of relevant literature.

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Background: There is a paucity of animal study investigating the effect of methamphetamine (METH) on penile erection in spite of its worldwide population. Aim: We investigated the changes of intracavernous pressure (ICP) elicited by cavernous nerve stimulation after a single and repeated dosing of METH in male rats. Methods: Rats were randomly assigned to five treated groups and one control group with each group having 3 rats. Rats in treated group 1, 2, and 3 received a single dose intravenous injection with 0.1, 1.0, and 10.0 μg/kg METH, respectively. Rats in treated group 4 and 5 received an intraperitoneal injection with 1.0 and 5.0 mg/kg METH four times daily for two weeks, respectively. ICP was measured during penile erection elicited by cavernous nerve stimulation. Expression of neural nitric oxide synthase (nNOS) was measured in the cavernous nerve and muscle after single and repeated dosing. Main Outcome Measures: The primary outcome measure was the ΔICP/mean arterial pressure (MAP) and the secondary was the expression of nNOS in the tissue. Results: The ΔICP/MAP increased slightly in group 1 rats and decreased substantially in group 2 and 3 rats compared with the baseline. A single dose of METH within the range of 0.1 to 10.0 μg/kg exhibited an inhibitory effect of ICP (%). The ΔICP/MAP significantly decreased in group 4 and 5 rats after repeated dosing of METH, compared with that in group 3. The expression of nNOS significantly increased in the cavernous muscle after single and repeated dosing of METH compared with the control. Conclusions: The preliminary results suggested that a single dose of METH exhibits an inhibitory effect on ICP and repeated dosing of METH exerted a greater inhibition than a single dosing. However, these results need further study.

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