Oral cancer is the fourth common male cancer and causally associated with environmental carcinogens in Taiwan. The reversion-inducing-cysteine-rich protein with Kazal motifs (RECK) has a significant effect on tumorigenesis by limiting angiogenesis and invasion of tumors through the extracellular matrix. RECK downregulation has been confirmed in many human cancers and associated with lymph node metastasis clinically. In the present hospital-based case-controlled study, the demographic, RECK genotype and clinicopathologic data from 341 male oral cancer patients and 415 cancer-free controls were investigated. We found that RECK rs10814325, rs16932912, rs11788747 or rs10972727 polymorphisms were not associated with oral cancer susceptibility. Among 488 smokers, RECK polymorphisms carriers with betel quid chewing have a 7.62-fold [95% confidence interval (CI), 2.96-19.64] to 25.33-fold (95% CI, 9.57-67.02) risk to have oral cancer compared with RECK wild-type carrier without betel quid chewing. Among 352 betel quid chewers, RECK polymorphisms carriers with smoking have a 6.68-fold (95% CI, 1.21-36.93) to 18.57-fold (95% CI, 3.80-90.80) risk to have oral cancer compared with those who carried wild-type without smoking. In 263 betel quid chewing oral cancer patients, RECK rs10814325 polymorphism have a 2.26-fold (95% CI, 1.19-4.29) risk to have neck lymph node metastasis compared with RECK wild-type carrier. These results support that gene-environment interactions between the RECK polymorphisms, smoking and betel quid may alter oral cancer susceptibility and metastasis.

The accuracy and clinical significance of sonography (US) in demonstrating fatty liver and hepatic fibrosis in chronic hepatitis C (CHC) are rarely reported. US had sensitivity 71.1%, specificity 72.9%, 58.7% positive predictive value (PPV), and 82.3% negative predictive value (NPV) in demonstrating histological steatosis > or =5%. US had sensitivity 85.7%, specificity 60.4%, 13% PPV, and 98.4% NPV in demonstrating histological steatosis > or =30% with clinical significance in predicting prognosis and therapeutic response in CHC. Subjects with fatty liver on US had a greater prevalence of body mass index (BMI) > or =25 kg/m2, inflammation-necrosis grade >2, and total bilirubin <1.2 mg/dl in multivariate analyses. US had sensitivity 27.4%, specificity 62.5%, 71.9% PPV, and 19.7% NPV in demonstrating histological fibrosis of stage II or above, and sensitivity 13.6%, specificity 66.3%, 9.4% PPV, and 75.0% NPV in demonstrating fibrosis of stage III or above. There was no correlation between fibrotic sonographic patterns and histological stage of fibrosis (r = -0.167, P = 0.083). Besides hepatic steatosis, clinicians should be alert to the possibility of advanced necrosis-inflammation grade in interpreting a report of bright liver on gray-scale US. Gray-scale US cannot replace liver biopsy as the optimal diagnostic procedure for the prediction of hepatic steatosis and fibrosis prior to initiating therapy for CHC.

Gastric glomus tumors are rare submucosal lesions that typically occur in the fourth endosonographic layer. We describe a 69-year-old patient who presented with intermittent epigastric pain and in whom a submucosal tumor was encountered during upper gastrointestinal endoscopy. Endosonography revealed a heterogeneous, hypoechoic fourth-layer tumor. Power Doppler imaging revealed prominent intratumoral vascular signals demonstrating its hypervascular nature. A diagnosis of glomus tumor was made via histopathologic evaluation of the resected tumor.

seudoaneurysms involving the superior mesenteric artery (SMA) and its branches are very rare. 1 Patients with SMA branch pseudoaneurysms usually present with nonspecific abdominal pain, and diagnosis is often delayed after the occurrence of rupture or bleeding. 2 Extracorporeal shock wave lithotripsy (ESWL) has been widely used to treat upper urinary tract calculi, although severe complications may be encountered. 3-8 To our knowledge, there are no previous reports pertaining to pseudoaneurysm formation in the SMA branch after ESWL of renal stones. We describe a novel case of pseudoaneurysm in the SMA branch presenting as a pusatile abdominal mass after ESWL. The probable association of ESWL with the pseudoaneurysm formation is discussed. CASE REPORTA 53-year-old man presented with recurrent right flank pain. He had undergone ESWL to treat a right renal stone 2 months earlier at another institution. Intermittent periumbilical pain developed after the procedure. The abdominal pain was nonspecific and was regarded as dyspepsia by his family physician. Ten days before coming to our hospital, he experienced recurrent right flank pain. He visited a urologist at our institution for initial evaluation. Abdominal examination was unremarkable and no palpable mass was detected. Renal ultrasonography showed a 1-cm renal stone over the lower pole of the right kidney. Initial urinalysis revealed pyuria and microscopic hematuria. He underwent a second session of ESWL to treat the right renal stone. No fever episodes were noted immediately after the procedure. However, the patient returned to the emergency department 1 day after ESWL reporting persistent periumbilical pain. The pain was described as cramping and bore no temporal relationship to mealtime. The patient's medical history was notable for hypertension and renal stones. He denied any history of surgeries, blunt abdominal trauma, or intravenous drug abuse. His family history was free of aneurysm or other cardiovascular diseases.During a physical examination, the patient was hemodynamically stable and had a low-grade fever of 37.7°C. The rest of the cardiorespiratory examination was unremarkable. Abdominal examination revealed a nontender pusatile mass in the left upper quadrant. No audible aneurysmal bruit was found. Laboratory data included a hematocrit of 39.8% (normal, 37% to 47%) and a white blood cell count of 10,800/ mm 3 (normal, 4,800 to 10,800/mm 3 ). Serum blood urea nitrogen was 12 mg/dL (normal, 8 to 20 mg/dL), and creatinine 1.8 mg/dL (normal, 0.7 to 1.5 mg/dL). Urinalysis demonstrated pyuria, positive leukocyte esterase, and numerous red blood cells. Blood and urinary cultures were negative for aerobic and anaerobic organisms. Chest X-ray and electrocardiography were unremarkable. Abdominal ultrasound disclosed a 5-cm, well-defined cystic lesion over the left upper quadrant. Contrast-enhanced computed tomography (CT) of the abdomen revealed a 5.0-cm, well-defined, septated enhancing mass within the mesentery and no evidence of paraaortic lymphadenopathy (...

No abstract