Molecular detection of the mammaglobin expression in the peripheral blood of Thai breast cancer patients.

Mammaglobin (hMAM) is expressed exclusively in the mammary glands of adult woman and mammary tumour cell lines. Thus, we examined hMAM expression as a market for the detection of carcinoma cells in the peripheral blood of patients with breast cancer in Thailand. In addition, we studied the correlation between hMAM expression in circulation mammary carcinoma cells and clinicopathological prognostic factors of breast cancer. Blood sample obtained from two hundred breast cancer patients at various stages of their disease and from sixty females without breast cancer (thirty healty individuals and thirty patients with various malignancies other than breast cancer) were screened for hMAM mRNA by a nested reverse transcriptase polymerase chain reaction (RT-PCR) assay. We found significant differences between patients with breast cancer and those with other malignancies or healthy controls. None of the samples from the peripheral blood of sixty females without breast cancer was positive, whereas sixty four (32%) of the two hundred sample from breast cancer patients tested positive for hMAM mRNA. While our hMAM nested RT-PCR approach has 100% specificity, its sensitivity is only 32%. The presence or absence of hMAM expression in these breast cancer patients was not associated with clinicopathological prognostic factors including stage, oestrogen and progesterone status, lymph node metastases, histological type, tumour size, differentiation, lymphatic invasion, vascular invasion, menopausal status or age. We summarized that the hMAM nested RT-PCR assay may be an effective tool for the detection of circulating mammary carcinoma cells of breast cancer patients. Nevertheless, the clinical relevance hMAM RT-PCR based tumour cell detections should be further evaluated in prospective studies.

Accuracy of conventional CT in predicting resectability of cholangiocarcinoma: A retrospective review.

Objective : Cholangiocarcioma is the common malignant bile duct tumor Thailand, particularly in the Northeastern part of the country. Since tumor resection is the curative treatment for Cholangiocarcioma, preoperative imaging plays and important role in evaluating the extension and resectability status of this tumor. This present work was designed to assess the capability of cinventional CT scan in predicting the resectability of Cholangiocarcioma. Materials and methods : Conventional CT of twenty three patients who had pathologically proven Cholangiocarcioma, were retrospectively reviewed between January 2002 and Decem ber 2002. The CT images were interpreted by 2 gastrointestinal radiologists with consensus. Results : The accuracy was 87%, positive predictive value 57% and negative predictive value 100%. Conclusion : CT scan remains and important tool that can provide valuable information regarding the criteria for resectability.

Pancreatic cancer : From clinical to molecular aspects.

Pancreatic ductal adenocarcinoma usually has a very poor outcome. The majority of patients present late with locally advanced or metastatic disease, and only 10-20% are candidates for resection. The tumor marker CA19-9 may be elevated but is not specific for pancreatic cancer. Dual-phase spiral computed tomography is the most important imaging modality for the diagnosis of pancreatic cancer. Despite the continuing development of body imaging methods and serum determination of tumor markers, the diagnosis of pancreatic carcinoma often remains problematic. Endoscopic retrograde cholangiopancreatography is considered to be one of the most reliable diagnostic procedures for pancreaticobiliary diseases. Endoscopic ultrasonography has been developed as an intracorporeal imaging method that now provides precise ultrasonic images of the pancreas. Pancreaticoduodenectomy is the mainstay of surgical treatment which offers the only hope of cure for this disease. Biliary-enteric and gastrojejunal bypass used to be the standard operation for inoperable pancreatic cancer. Endoscopic stenting can produce good palliation of biliary obstruction. The median survival after resection is only 18-20 months and up to 50% of those who survive 5 years may die of recurrent cancer. The factors that predict recurrence and survival are the resection margin, the size of the tumor, lymph node involvement and histological appearance of the degree of differentiation of the cancer tissue. Pancreatic cancer is a consequence of stepwise accumulated genetic alterations which disturb the equilibrium of a cell by altering the relative balance between the roles of the cell cycle, differentiation and dedifferentiation, and programmed cell death (apoptosis). Multiple genetic alterations involving the activation of oncogenes (K-ras) and inactivation of tumor suppressor genes (p53, p16 and DPC4) and telomerase. The detection of early tumor, i.e., the establishment of a screening strategy, the development of adjuvant therapy and molecular approaches might provide more options and a better clinical outcome for pancreatic cancer.

Discordant cardiac troponin results in amphetamine - related rhabdomyolysis.

A case of a patient who developed amphetamine-related rhabdomyolysis and acute renal failure after an intestinal operation is reported. He initially had biochemical evidence of myocardial injury, with a concomitant increase in cardiac marker proteins CK-MB, cardiac troponin T (cTnT) and cardiac troponin I (cTnI) during the acute event. Following intensive treatment and improvement in renal function, levels of all myocardial marker proteins fell towards the normal range. Late in the course of the disease, however, there were re-elevations of CK-MB and cTnT, but not of cTnI, to levels exceeding 14 fold and 8 fold the upper limit of the reference range, respectively. Since, at present the possibility of re-expression of both CK-MB and cTnT in damaged and regenerating skeletal muscle can not be ruled out, the late occurrence of increased CK-MB and cTnT in our patient should not be interpreted as evidence of recurrent myocardial injury.

Novel aspects in the management of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the commonest cancers in Thailand, which usually develops on a background of cirrhosis. We report a multimodal approach to the management of HCC. Though surgical treatment is the only opportunity for curing HCC, it is only feasible in a minority of patients. Various non-surgical treatment modalities have been developed and used extensively, but their efficacy is far from satisfactory and the prospect for the development of more effective treatments is dismal. Multidisciplinary treatment such as the combination of transcatheter oily chemoembolization and percutaneous ethanol injection appears to be the current trend of management for nonresectable HCC, and improvement in survival can be achieved compared to single mode treatment. Portal vein embolization is useful in patient in need of wide hepatectomy to induce pre-operative hypertrophy of future remnant liver, which would have been insufficient for safe resection. Moreover, intra-arterial 131-Iodine-Lipiodol given after curative resection significantly decreased the rate of recurrence and increased disease-free and overall survival in patients with HCC.