Background: Colorectal cancer (CRC) is a common and lethal disease in the world. There is an increasing number of cases in Taiwan and a higher rate at advanced stages. The immune fecal occult blood test (iFOBT) has been used as a screening method in Taiwan for years. A new novel diagnostic tool, the Methylated Septin-9 (MS-9) DNA blood test, had been reported to have high sensitivity and specificity for CRC detection. There are no available data in Taiwan, so we conducted this prospective randomized trial to investigate the relationship among the MS-9 DNA blood test, iFOBT, and a combination of the two tests for diagnosing CRC in Taiwanese people. Methods: From July 1, 2012 to December 31, 2013, we prospectively selected 60 plasma samples from patients who were diagnosed with CRC and otherwise, the healthy group by colonoscopy in our hospital. Patients were divided into the CRC group and healthy group. CRC stages 0, I, II and stages III and IV were separately analyzed. We calculated the sensitivity and specificity of each group to determine the relationship among the MS-9 DNA blood test, iFOBT, and a combination of the two tests for diagnosing CRC in Taiwanese people. Results: The results of the MS-9 DNA blood test for the 60 samples were divided into three groups, and the sensitivity as well as the specificity of the MS-9 DNA blood test to detect CRC were 47% and 89%, respectively. The results of iFOBT were also divided into three groups, and had higher sensitivity (84%) but lower specificity (55%) using iFOBT to detect CRC. Higher rates could be predicted to detect CRC if both the tests were positive. Conclusions: A combined MS-9 DNA blood test and iFOBT may help in a higher detection rate of CRC. It could be offered to individuals who are unwilling or unable to undergo colonoscopy. Further large prospective, randomized studies are needed in the future.

INTRODUCTIONHepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. It is usually manifested in the 6th and 7th decades of life. Extrahepatic metastases are seen in 64% of patients with HCC. The most frequent sites of extrahepatic metastases are lung, abdominal lymph node and bone, but peritoneal dissemination is unusual [1,2] . The incidence of spontaneous rupture of HCC is about 8%-26% in Asia [3][4][5] and the mortality rate of HCC patients is 10% [6] . However, peritoneal metastasis of HCC after spontaneous rupture is seldom noted. Here, we report a case of intraperitoneal metastasis of HCC after spontaneous rupture 10 mo ago, which was treated with transarterial embolization. CASE REPORTA previously asymptomatic 72-year-old man had a history of chronic hepatitis C-related liver cirrhosis without regular follow-up. Sudden nausea and vomiting with watery diarrhea were noted on January 2006. Then he was sent to Yun-Lin Branch of National Taiwan University Hospital for help. Abdominal computer tomography (CT) scan showed a huge HCC that was suspicious of rupture. Under the request of his family, he was transferred to our hospital and transarterial embolization was performed on January 31, 2006. After discharge, he was regularly followed up at our Gastrointestinal (GI) Outpatient Department (OPD). Dull abdominal pain over the right upper quadrant area, accompanied with fullness sensation, was noted in November 2006. Besides, he also had body weight loss of about ten kilograms in one year. So he visited our hospital again. Abdominal CT scan revealed a peritoneal mass in the right upper quadrant peritoneal area and hepatoma recurrence was considered ( Figure 1). Transarterial embolization was arranged again, but failed. After consultation with the surgeon, he was admitted for surgical resection.Surgical intervention was arranged on January 24, 2007. Operative methods were segmental hepatectomy (S6 and partial S5), excision of extrahepatic tumor, and cholecystectomy. The operation showed a huge tumor (12 cm × 8 cm × 6 cm) over the right upper quadrant area just below liver parenchyma (Figure 2) with its blood supplied from the omentum. Besides, two small mass lesions (3 cm × 2 cm and 2 cm × 1 cm) were found over AbstractRupture of hepatocellular carcinoma (HCC) is a lifethreatening complication. Peritoneal metastasis of HCC after spontaneous rupture was seldom noted. We report a case of intraperitoneal metastasis of HCC after spontaneous rupture. A previously asymptomatic 72-yearold man was admitted due to dull abdominal pain with abdominal fullness. He had a history of HCC rupture 10 mo ago and transarterial embolization was performed at that time. Abdominal computer tomography (CT) scan showed a huge peritoneal mass over the right upper quadrant area. Surgical resection was arranged and subsequent microscopic examination confirmed a diagnosis of moderately-differentiated HCC.

Background: Mucoceles resulting from cystadenomas of the appendix are uncommon. Although rare, rupture of the mucoceles can occur with or without causing any abdominal complaint. There are several reports associating colonic malignancy with cystadenomas of the appendix. Herein, we report an unusual and interesting case of right inguinal hernia associated with left colon cancer.

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 (...

LA is as safe and effective as OA in many settings of appendicitis and may be selectively advantageous in patients with complicated appendicitis and in elderly subgroups.