Weekly paclitaxel combining with gemcitabine is an effective and safe treatment for advanced breast cancer patients.

OBJECTIVE: Patients with metastatic breast cancer usually accept several lines of chemotherapy. This retrospective study is to analyze the therapeutic effect and tolerance of weekly paclitaxel/gemcitabine combination on patients with metastatic breast cancer. METHODS: Paclitaxel 80 mg/m(2) and gemcitabine 800 mg/m(2) were administered sequentially on days 1, 8 and 15 every 28 days. Patients with measurable metastatic breast cancer or locally advanced breast cancer were included. RESULTS: From March 2005 to December 2006, 50 patients received this treatment at Chang Gung Memorial Hospital, Kaohsiung Medical Center. Thirteen (26%) patients accepted this regimen as their first-line treatment for metastatic breast cancer and 25 (50%) patients accepted this regimen after at least three lines of therapies for metastatic breast cancer. The overall response rate was 56% (95% confidence interval: 42.2-69.8%), 2 patients achieved complete response and 26 patients (52, 95% confidence interval: 38.2-65.9%) achieved partial response. The median progression free survival was 7.4 months (95% confidence interval: 5.5-9.3 months), and the median overall survival was 19.0 months (95% confidence interval: 9.7-28.3 months). Except alopecia, the most common Grade 3/4 toxicities were anemia and leucopenia; the incidences of both were fewer than 10%. CONCLUSIONS: The combination of weekly gemcitabine and paclitaxel in patients with advanced breast cancer showed acceptable outcome and excellent toxic profiles. This therapeutic benefit could be achieved in any linage of patients with good performance status; earlier usage of this regimen can provide better result.

Stress response to hepatectomy in patients with a healthy or a diseased liver.

Partial hepatectomy is a major upper abdominal operation associated with certain stress to the patient. Successful adaptation to such stress is a prerequisite for survival. Donor hepatectomy with maximal safety is a principal concern during living donor liver transplantation. The purpose of the study was to compare the stress response by assessing cytokines and the acute-phase response induced by hepatectomy in patients with a healthy liver and those with a diseased liver. Fourteen patients undergoing partial right hepatectomy were enrolled in this study. Seven of them were donors for living related liver transplantation (group 1, or GI); the other seven were patients with hepatocellular carcinoma due to chronic hepatitis B (Child's class A) (GII). Blood samples for interleukin-6 (IL-6), tumor necrosis factor-alpha (TNFalpha), and C-reactive protein (CRP) assays were collected before the operation, at the beginning and end of the operation, and 24 and 48 hours after the operation. The data were analyzed and compared in the same group using the Friedman test and between groups using the Mann-Whitney U-test. A value of p < 0.05 was regarded as significant. Results showed that resection of the liver in patients with both healthy and disease livers leads to significant increases in IL-6 and CPR but not TNFalpha. Significantly lower levels of IL-6 before and after operation in GI patients compared to those in GII patients suggests that GI patients adapted to surgical stress more easily than did the GII patients.

Vertical banded gastroplasty: a simple, effective and safe surgery for morbid obesity.

BACKGROUND: The purpose of this study was to analyze the data of 92 patients who were treated with vertical banded gastroplasty (VBGP) for morbid obesity. We wanted to show that VBGP is a simple, effective and safe surgery for an experienced gastrointestinal surgeon. METHODS: From January 1994 through June 2000, 92 patients with morbid obesity who were treated with VBGP were enrolled into this study. All associated data were corrected and analyzed. The gastric pouch was created with end-to-end anastomosis instrument (EEA-31) and two applications of thoracic anastomosis instrument (TA)90-4.8 or TA90-B. The outlet of the gastric pouch was 10 to 12 mm in diameter. The results were classified as excellent, good, fair, poor, and bad. RESULTS: Staple disruption occurred in four patients with two applications of TA90-4.8 at the beginning of the series. No surgical deaths occurred. Fifteen patients had excellent results. Thirty-eight patients had good results. Twenty-three patients had fair results. Only 16 patients had poor or bad results. CONCLUSION: VBGP is a simple, effective and safe surgery for an experienced gastrointestinal surgeon in management of morbid obesity. The associated morbidity and mortality rates are low and the results are good.