RESUMEN
In this model of hepatic micrometastases, the antitumor efficacy and role of the T-cell and natural killer (NK) cell populations were studied for oncolytic herpes simplex virus type-1 (HSV-1) viral mutants containing the granulocyte-monocyte colony stimulating factor (GM-CSF (NV1034)) or interluken-12 (IL-12 (NV1042)) cytokine genes. These were compared to saline and control virus (NV1023) in vitro and in vivo. HSV-1 mutants were assessed for cytotoxicity, replication and cytokine expression in CT-26 cells. A syngeneic micrometastatic liver model was then established in naive and immune cell-depleted animals to assess the antitumor efficacy of these viruses. In vitro cytotoxicity and viral replication were similar for each virus, resulting in greater than 80 and 98% cytotoxicity at multiplicity of infection of 1 and 10, respectively. Peak viral titers were 25- to 50-fold higher than initial titer and were not significantly different between viruses. In vivo, all three viruses reduced metastases relative to control, but cytokine-secreting viruses did so with greater efficacy compared to NV1023. This effect was abrogated by T-cell depletion, but not NK-cell depletion. Single-agent therapy with oncolytic viral agents containing GM-CSF or IL-12 is effective in a murine model of liver metastases and likely involves direct viral oncolysis and actions of specific immune effector cells.
Asunto(s)
Neoplasias Colorrectales/terapia , Viroterapia Oncolítica , Simplexvirus/genética , Animales , Técnicas de Cultivo de Célula , Neoplasias Colorrectales/inmunología , Neoplasias Colorrectales/patología , Citocinas/genética , Citocinas/inmunología , Citocinas/metabolismo , Terapia Genética , Vectores Genéticos/genética , Hígado , Ratones , Modelos Animales , Linfocitos T/citología , Linfocitos T/inmunología , Linfocitos T Reguladores/inmunologíaRESUMEN
Carotid endarterectomy (CEA) was established as the gold standard for treatment of carotid occlusive disease by several landmark papers published in the 1990's. Several decades of experience with CEA, however, has revealed high-risk subsets of patients in whom CEA carries increased risk of adverse events. These patients have subsequently been the focus of several randomized trials and registry databases which evaluated and proved non-inferiority of carotid angioplasty and stenting (CAS) in recent years. CAS is now considered an appropriate and equivalent alternative to CEA in these high-risk patients, defined by the presence of severe cardiac, pulmonary, or renal disease or by the presence of local factors such as prior neck radiation, prior neck operations, contralateral carotid occlusion, or surgically inaccessible lesions. Although ongoing trials in normal-risk patients may ultimately expand the indications for CAS, there is currently insufficient evidence to recommend CAS in these patients over CEA. In addition, specific subsets of patients, such as octogenarians or those with anatomic complexity, may have increased incidence of adverse events with CAS and are best served by CEA.
Asunto(s)
Angioplastia , Arteriopatías Oclusivas/cirugía , Arteria Carótida Común/patología , Arteria Carótida Común/cirugía , Endarterectomía Carotidea , Stents , Angioplastia/tendencias , Arteriopatías Oclusivas/patología , Implantación de Prótesis Vascular/tendencias , Endarterectomía Carotidea/tendencias , Humanos , Selección de Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de RiesgoRESUMEN
An 82-year-old woman presented with abdominal pain, nausea, emesis, and weight loss of ~25 lb over 6 months. A CT scan and MRI of the abdomen revealed a mass in the tail of the pancreas that was suspicious for malignancy. The patient underwent successful laparoscopic distal pancreatectomy and was discharged home on the 4th postoperative day after an uneventful course. Pathology revealed an inflammatory pseudotumor of the pancreas (IPT). Pancreatic IPT is a rare entity, and this case represents the first report of laparoscopic resection of this lesion. The presentation, diagnosis, histologic features, and therapy of IPT of the pancreas are reviewed.
Asunto(s)
Granuloma de Células Plasmáticas/cirugía , Laparoscopía/métodos , Pancreatectomía/métodos , Enfermedades Pancreáticas/cirugía , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Granuloma de Células Plasmáticas/diagnóstico , Granuloma de Células Plasmáticas/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Enfermedades Pancreáticas/diagnóstico , Enfermedades Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Crohn's disease confined to the appendix is rare but has been well described in the literature. It can mimic acute appendicitis clinically. After surgical treatment, recurrences of Crohn's disease are rare. We report the first case of treatment by laparoscopic appendectomy of Crohn's disease confined to the appendix. METHODS: A healthy 32-year old man presented with a week-long history of vague lower abdominal pain. Diagnostic work-up, which included CT, enteroclysis, and routine blood work, revealed a patent appendiceal lumen with an inflammatory mass in the right lower quadrant. RESULTS: Diagnostic laparoscopy revealed an inflamed appendix, and a laparoscopic appendectomy was performed, with frozen-section examination revealing Crohn's disease of the appendix. Two years after surgery, the patient has not had a recurrence of symptoms. CONCLUSIONS: Crohn's disease of the appendix can mimic acute appendicitis, although often with a more indolent course. The disease may be treated successfully by laparoscopic appendectomy, with good long-term results.