The Kaohsiung Journal of Medical Sciences

The current study is a retrospective analysis of 49 patients with bone metastatic prostate cancer: 26 receiving androgen deprivation therapy (ADT) alone versus 23 receiving cytoreductive cryosurgery of the primary tumor plus ADT treatment. Progression‐free survival (PFS) was the primary outcome variable, and Cox proportional hazards regression analysis was used to identify predictors for PFS. The baseline characteristics were generally comparable between the 2 groups. Median follow‐up time was 41 months (range 24–56) and 37 months (range 19–53) in ADT alone group and cryosurgery groups, respectively. Patients receiving cryosurgery had significantly longer PFS (35 vs 25 months, P = 0.0027) and time to castration resistance (36 vs 25 months, P = 0.0011). Cox multivariate analysis associated longer PFS with the following factors: cryosurgery (HR0.207, 95% CI 0.094–0.456), lower prostate specific antigen at diagnosis (≤100 ng/ml, HR0.235, 95% CI 0.072–0.763) and lower Gleason score (≤7, HR0.195, 95% CI 0.077–0.496). Cryosurgery reduced the risk of progression by 79.3%. In conclusion, cytoreductive cryosurgery of the primary tumor in patients with bone metastatic prostate cancer could reduce the risk of progression and delay time to castration‐resistant prostate cancer.

α‐Carboline (pyrido[2,3‐b]indole) was selected as the basic scaffold for development of antileukemic agents by structural modification. From the structure‐activity study, it was found that sequential introduction of 6‐acetyl and 9‐substituted benzyl groups onto an α‐Carboline scaffold resulted in 6‐acetyl‐9‐(3,5‐dimethoxybenzyl)‐9H‐pyrido[2,3‐b]indole and 6‐acetyl‐9‐(3,4,5‐trimethoxybenzyl)‐9H‐pyrido[2,3‐b]indole with potent cytotoxicity against the HL‐60 cell line. These two compounds will be used as new lead compounds for further investigation.

As we pay increasing attention to dental aesthetics, tooth color matching has become an important part of daily dental practice. This aim of this study was to develop a method to enhance the accuracy of a tooth color matching machine. The Munsell color tabs in the range of natural human teeth were measured using a tooth color measuring machine (ShadeEye NCC). The machine's accuracy was analyzed using an analysis of variance test and a Tukey post‐hoc test. When matching the Munsell color tabs with the ShadeEye NCC colorimeter, settings of Chroma greater than 6 and Value less than 4 showed unacceptable clinical results. When the CIELAB mode was used, the a* value (which represents the red–green axis in the Commission Internationale de l'Eclairage color space) made no significant difference (p = 0.84), the L* value (which represents the lightness) resulted in a negative correlation, and the b* value (which represents the yellow–blue axis) resulted in a positive correlation with ΔE. When the Munsell color tabs and the Vitapan were measured in the same mode and compared, the inaccuracies showed that the Vitapan was not a proper tool for evaluating the stability and accuracy of ShadeEye NCC. By knowing the limitations of the machine, we evaluated the data using the Munsell color tabs; shade beyond the acceptable range should be reevaluated using a visual shade matching method, or if measured by another machine, this shade range should be covered to obtain more accurate results.

The suppression of immune responses in malignant gliomas is thought to be involved in glioma pathogenesis. The newly identified tumor‐secreted soluble decoy receptor 3 (DcR3) can bind to the ligands CD95L and LIGHT, thereby neutralizing their pro‐apoptotic actions. Little is known of the production of DcR3 by glioma cells. This study investigated the serum concentration of DcR3 in glioma patients before and after tumor removal. Blood samples were taken from 17 glioma patients and 10 control patients. The serum DcR3 concentration was measured using a DcR3 enzyme‐linked immunosorbent assay. There was no statistically significant difference between preoperative (0.069 % 0.027 ng/mL) and postoperative DcR3 concentrations (0.068 % 0.022 ng/mL; p = 0.951). Similarly, there was no difference in preoperative DcR3 concentration between glioma patients (0.069 % 0.027 ng/mL) and controls (0.063 % 0.023 ng/mL; p = 0.106). Our study demonstrated no alteration in DcR3 concentration in glioma patients before and after tumor removal.

Abscess formation within a brain tumor is uncommon. Intrasellar or parasellar tumors are the most common neoplasms that develop such complications. Cerebral gliomas with abscesses are extremely rare. In this paper three rare cases of glioma associated with abscess formation are described. The diagnosis of brain tumor associated with abscess is particularly difficult by conventional neuroradiological studies. ^99mTc‐labeled sulesomab can be useful in the diagnosis of brain tumors with intratumoral abscesses. There are no precise guidelines for the diagnosis and treatment of cerebral gliomas associated with abscesses formation for the low number of cases reported to date. Appropriate treatment, aimed at radical surgery, and a suitable antibiotic‐protocol, deferring adjuvant postoperative therapy, is associated with a more favorable outcome. A review of the pertinent literature is also performed.

Malaria, a major public health problem worldwide, is a predominant infectious disease in most tropical and subtropical countries. Before 1965, Taiwan was a hyperendemic area, but most cases are now imported. We present our experience of dealing with various malaria infections. Charts of malaria patients visiting university hospitals in southern Taiwan between January 1991 and June 2002 were available for review. All diagnoses were made by positive blood smear and detailed history that included countries visited, paroxysm of symptoms, and medical treatment. Seventeen patients, 6 women and 11 men (mean age, 32.3 ± 11.8 years), were enrolled. Six were infected with Plasmodium falciparum, eight with Plasmodium vivax, two with a combination of P. falciparum and P. vivax, and one with an unidentified infection. All Taiwanese patients infected with P. falciparum (n = 5) contracted the disease in Africa or Indonesia. All Taiwanese patients infected with P. vivax (n = 4) contracted the disease in Southeast Asia or Oceania. Fever and chills were the leading symptoms of malaria. P. falciparum infection was treated with quinine and doxycycline/tetracycline, with the addition of artesunate for cerebral malaria. P. vivax infection was treated with chloroquine and primaquine. Maintaining a high degree of suspicion in patients with a history of travel to malaria‐endemic areas is the major cornerstone of malaria diagnosis. Erroneous diagnosis and improper treatment leads to greater morbidity and even mortality.

Extensively drug‐resistant Acinetobacter baumannii (XDRAb) emerges as an important pathogen of health care–associated infections and outbreaks worldwide. During January and February 2006, there was a hospital‐wide outbreak of XDRAb at a medical center in Taiwan. Without limiting the usage of carbapenems or the closure of any ward, this outbreak was effectively controlled. We investigated the molecular epidemiology and reported the infection control experiences. XDRAb is defined as A baumannii that is resistant to multiple antibiotics but susceptible to tigecycline and polymyxin B. During the outbreak, the clinical and environmental XDRAb isolates were collected and studied by antimicrobial susceptibility testing, pulsed‐field gel electrophoresis, and polymerase chain reaction for Verona integron‐encoded metallo‐beta‐lactamases, imipenemases, and oxacillinases (OXA). Our measures to control the outbreak included private room isolation of patients until there were three successive negative cultures, reinforcement of contact precautions, daily environmental cleansing with room‐dedicated cleaning tools and sodium hypochlorite, and careful auditing of adherence. During the outbreak, 32 clinical XDRAb isolates came from 13 patients who were hospitalized in four intensive care units and three wards. Most (7 of 13, 53.8%) cases were associated with a surgical intensive care unit. The results from pulsed‐field gel electrophoresis study indicated that all isolates were of one genotype. All 32 isolates harbored ISAba1‐bla_{OxA‐51‐like} and bla_OxA‐72 genes. After this outbreak till August 2010, further incidences of XDRAb were sporadic cases of XDRAb with different clones and did not reach the level of outbreak. To our knowledge, this is the first reported hospital‐wide outbreak caused by OXA‐72 carbapenemase–producing A baumannii in the Asia‐Pacific region, with successful and sustained control. Although the source or vehicle of the outbreak was not identified, our results suggest that a hospital‐wide outbreak can be successfully managed with strict infection control measures, and that the limitation of the use of carbapenems and closure of wards may not be necessary.

A medium‐sized general hospital using a fee‐for‐service model implemented a hospital‐wide picture archiving and communication system (PACS) in two stages. This study evaluated the reporting time with filmless operation and the effect of filmless imaging on referring physicians' use of the radiologic service before and after completion of the second stage of PACS implementation. The relationship between the total number of hospital patients and the number of radiologic department patients was also evaluated. All sample images were retrieved from the PACS. All corresponding reports except for one for a computerized tomography study were available. The median reporting time for different studies performed during working hours was less than 2 hours. There was a significantly positive and linear relationship (p < 0.01) between the total number of hospital patients and the number of radiologic department patients after hospital‐wide implementation of PACS. We conclude that the fee‐for‐service model had no negative impact on referring physicians' use of radiologic services in a filmless hospital.

Fournier's disease, a form of necrotizing fasciitis, is a rapidly progressing subcutaneous infection of the male genitalia. We report a case of Fournier's disease with the unusual etiology of a perforated duodenum. This patient suffered from progressive right scrotal swelling after percutaneous transhepatic cholangeal drainage. Scrotal exploration revealed a large abscess with muscle necrosis that had spread up to the right retroperitoneal space. Radiologic studies and second abdominal exploration documented the origin as a perforated duodenum. The pus distribution in this case suggested that the infection process differed from that in previous reports. In future cases of Fournier's disease involving previous abdominal events, we recommend that abdominal origins be carefully surveyed before scrotal exploration.