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  Citation statistics : Table of Contents
   2018| July-August  | Volume 51 | Issue 4  
    Online since August 22, 2018

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Chloroquine induces lysosomal membrane permeability-mediated cell death in bladder cancer cells
Hung-En Chen, Ji-Fan Lin, Yi-Chia Lin, Shen-I Wen, Shan-Che Yang, Te-Fu Tsai, Kuang-Yu Chou, I-Sheng Thomas Hwang
July-August 2018, 51(4):133-141
Background: Chloroquine (CQ) is recognized as a potent adjuvant when combined with other chemotherapies to treat cancers. However, the effects of a single treatment of CQ on bladder cancer (BC) cells have not been investigated. Methods: The growth and viability of CQ-treated BC cells were examined. The lysosomal morphology was detected using LysoTracker. The induction of lysosomal membrane permeability (LMP) was detected by acridine orange (AO) translocation, and cathepsin B and D release. The expression of the bid, caspase-3, and cytosolic cytochrome C (Cyto. C) in CQ-treated cells was detected by the Western blot. The pepstatin A and E64d were used to attenuate CQ-induced LMP. Results: A single dose of CQ treatment induced BC cell death, and attenuated by pepstatin A and E64d. The diminishing of fluorescent in CQ-treated cells stained with LysoTracker, suggesting that CQ targets lysosomal functions. This was further supported by increased AO translocation and the releasing of CatB and CatD into the cytosol. The increased level of cleavage bid and cytosolic Cyto. C indicated mitochondrial outer membrane permeabilization and subsequently leading to apoptosis induction judged by the increased level of activated caspase 3. Conclusion: CQ-induced LMP that enhances apoptosis and ultimately leading to BC cell death. The study results demonstrated for the first time that single CQ treatment against BC cells by inducing LMP and subsequent mitochondria membrane permeability that trigger apoptosis, making it a potential treatment for BC therapy in the future.
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Surgical intervention of a giant gastric gastrointestinal stromal tumor following neoadjuvant therapy with imatinib
Chien-Yang Wang, Kong-Han Ser, Wai-Sang Kuan, Wei-Jei Lee
July-August 2018, 51(4):162-166
Gastrointestinal stromal tumors (GISTs) treatment has improved remarkably in recent years. However, giant and unresectable lesions could still be challenging, especially from the surgical aspect. We reported a case of a 44-year-old male patient who complained about abdominal pain and distention. Computed tomography scans, upper GI endoscopy, and tissue biopsy proved the diagnosis of a giant GIST which was considered unresectable. With the aid of neoadjuvant imatinib therapy, the tumor shrank tremendously, and we successfully performed en bloc resection with clean margins. Therefore, we suggested combining imatinib therapy and surgery in managing giant and unresectable GIST lesions.
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Heterotopic subserosal pancreatic tissue in jejunum
Manish Swarnkar, Priyansh Pandey
July-August 2018, 51(4):167-170
Heterotopic pancreas (HP) is typically an asymptomatic malformation that can present anywhere along the gastrointestinal tract. It is frequently detected incidentally on surgery for other diseases or autopsy. We encountered an incidentally detected subserosal nodule in proximal jejunum during exploratory laparotomy for other cause which was resected and on histopathology confirmed to be HP. Histologically, most of the tumors are located in the submucosa, rarely in the muscularis propria, and only seldom in the subserosal. This case is of great interest because of the subserosal location of the tumor.
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Idiopathic isolated omental panniculitis presenting with intestinal obstruction
Vipul D Yagnik
July-August 2018, 51(4):171-174
Intra-abdominal panniculitis is a rare condition characterized by intraperitoneal lipodystrophy that may manifest as a necrotic adipose lump causing symptoms due to inflammation or mass effect. Although this condition tends to primarily affect the root of the mesentery, it may affect any part of the peritoneum, including the omentum. However, isolated omental panniculitis, in which no other site is affected, is a very rare form of intra-abdominal panniculitis and only eight cases have been reported in the literature so far. Mesenteric panniculitis, especially in the late fibrous stage of retractile mesenteritis, is known to occasionally cause intestinal obstruction by virtue of its relation to the bowel. However, omental panniculitis has only been reported to cause nonspecific inflammatory symptoms. We present a case of isolated omental panniculitis of indeterminate etiology. To the best of our knowledge, this is the first such case reported to present with intestinal obstruction.
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Surgical treatment for duodeno-reno-cutaneous fistula
Kuo-Yang Hsi, Jiann-Ming Wu, Kuo-Hsin Chen
July-August 2018, 51(4):158-161
We report the case of a 58-year-old man diagnosed as having right renal stones and who had undergone shock wave lithotripsy several times. However, residual stones persisted and resulted in pyelonephritis and renal abscess. Percutaneous nephrolithotomy (PCNL) was performed. However, bile content discharge from the PCNL wound was observed later. Abdominal computed tomography revealed multiseptated right renal abscess with the right psoas muscle involvement and obscure plane between the right kidney and the duodenum. A fistulogram demonstrated the presence of duodeno-reno-cutaneous fistula. He underwent right nephrectomy and wedge resection of the duodenum for the closure of the fistula. The postoperative course was smooth, and the PCNL wound healed spontaneously during the admission. He remained asymptomatic 6 months after the operation. This report includes a literature review on the etiology, diagnosis, and treatment of the renoduodenal fistula.
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The use of perforator flaps for the reconstruction of sacral defects: Ten-year experience
Hao-Yu Chiao, Shun-Cheng Chang, Chang-Yi Chou, Yuan-Sheng Tzeng, Shyi-Gen Chen, Chin-Ta Lin
July-August 2018, 51(4):142-147
Background: Despite advances in reconstruction techniques, sacral defects continue to challenge surgeons. The perforator flap preserves the entire contralateral side as a future flap donor site and the gluteal muscle itself on the ipsilateral side to minimize donor-site morbidity. Materials and Methods: Between April 2003 and March 2013, data obtained from 60 patients with sacral defects reconstructed with perforator flaps were retrospectively analyzed. Results: We analyzed the sacral defects reconstructed with three different perforator flaps into the following groups: group 1, 30 patients with superior gluteal artery perforator flaps, (average flap size was 83.8 cm2); Group 2, 19 patients with parasacral perforator flaps (average flap size was 94.2 cm2); and Group 3, 11 patients with inferior gluteal artery perforator flaps (average flap size was 85.8 cm2). The overall flap survival rate was 93.3% (56/60). Conclusion: Perforator flaps are a reliable option for soft-tissue defect reconstruction as they provide a sufficient amount of tissue to cover large sacral defects. We recommend perforator flaps as a viable alternative in the management of sacral defects that cannot be reconstructed with primary closure or local fasciocutaneous flaps.
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The result of emergency cardiac intervention in resuscitated out-of-hospital cardiac arrest patients
Hsieh Ming-Yu, Hsien-Hua Liao, Shih-Chen Tsai, Ying-Hock Teng, Po-Yu Chen, Su-Chin Tsao, Ching-Feng Tsai, Kuei-Chuan Chan, Jung-Ming Yu, Yi-Liang Wu, Tsung-Po Tsai
July-August 2018, 51(4):148-152
Background: Arrhythmia and sudden cardiac decompensation (acute myocardial infarct or acute heart failure) are the most often causes of out-of-hospital cardiac arrest (OHCA). Emergency cardiac catheterization followed by coronary revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting surgery [CABG]) or valvular surgery is a lifesaving procedure. However, the result of this emergency room resuscitated OHCA patients underwent cardiac invasive procedure was not well defined before. Materials and Methods: One hundred and seventy (including 23 traumatic and stroke, etc.,) out of 705 OHCA patients were resuscitated and achieved a return of spontaneous circulation (ROSC) at Emergency Room of Chung Shan Medical University Hospital from January 1, 2011, to March 31, 2015. Only 23 (M/F = 25/8) out of 147 medically resuscitated OHCA patient with one or more cardiac risk factors were transferred for emergency cardiac catheterization (33/147). Thirty-one of them (31/33) underwent PCI (either balloon angioplasty or stent deployment) with coronary culprit stenotic lesions (>70%) of right coronary artery (15), left anterior descending artery (12), circumflex branch of left coronary artery (5), and left main coronary artery (1). One of the rest two patients with aortic valvular stenosis who underwent aortic valve replacement; and another with triple vessel disease of coronary artery received CABG. Results: All 33 patients (22.4%) survived the catheterization procedures and were sent to intensive care units. 31 patients were in comatose state and 24 eventually deceased due to cardiogenic shock (16), septic shock (4), ventricular tachycardia and ventricular fibrillation (2), hyperkalemia (1) and multiple organ failure (1). Nine patients (27.3%) survived to hospital discharge and were followed up at OPD periodically (1.3–43 months, mean 30.4 months). Four OHCA patients required extra-corporeal membrane oxygenation support, but only one out of four underwent PCI and survived. Conclusions: The resuscitated OHCA (ROSC) patients with any cardiac disease in the past should undergo emergency cardiac catheterization and possible intervention procedure with an acceptable result (survival to hospital discharge rate of 27.3%).
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Laparoscopic liver resection for polycystic liver disease
Kuo-Hsin Chen, Tiing-Foong Siow, Ying-Da Chen, U-Chon Chio, Yin-Jen Chang, Chao-Man Loi, Tzu-Chao Lin, Shu-Yi Huang, Chih-Ho Hsu, Jiann-Ming Wu, Kuo-Shyang Jeng
July-August 2018, 51(4):153-157
Introduction: Polycystic liver disease is uncommon and usually asymptomatic. Surgery is indicated for patients with symptoms or complications. Cyst fenestration has been the main surgical option despite the relatively high recurrence rate. Open hepatectomy and fenestration provided sustainable symptomatic relief in selected patients at the cost of higher morbidity. The role of laparoscopic hepatectomy (LH) for this entity remains unclear. Methods: A retrospective review of patients with polycystic liver disease receiving LH was undertaken. LH in this study referred to the removal of part of normal liver or complex cysts by dividing Glissonean pedicles to the specimen, excluding simple cyst fenestration. Indication for surgery included symptoms related to mass effect with image-confirmed compression on stomach or duodenum and cyst infection. Results: From December 2004 to September 2016, a total of 14 patients (12 females and 2 males) with a mean age of 55.9 ± 14.0 years had been enrolled. Gigot's classification in this series includes type I in 3, type II in 8, and type III in 3 cases. Extent of liver resection includes partial S2 and S3 in 6, partial S2 and S3 with associated partial S5 and S6 or S7 in 3, partial S5, S6, and S7 in 1, partial S6 and S7 in 1, left hepatectomy in 2, and right hepatectomy in 1. Perioperative outcomes include median operation time of 240 min (60–300, interquartile range [IQR]: 150), estimated blood loss of 50 ml (5–2000, IQR: 98.8), and mean postoperative hospital stay of 5.5 days (2–77, IQR: 7.3). The 90-day postoperative complications developed in three patients, mainly bile leak and pleural effusion. There was no postoperative mortality. Conclusion: Laparoscopic liver resection and fenestration for polycystic liver disease seem safe and feasible. The perioperative outcomes were acceptable although the bile leakage rate was relatively high. Careful patient selection to choose peripheral lesions is advisable.
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