RESUMEN
BACKGROUND: Early-stage non-small cell lung cancer (NSCLC) patients have a high risk of disease relapse despite curatively intended surgical resection, and the detection of tumour cells in the bone marrow could be one method of determining the presence of the disseminated disease in its early stages. METHODS: Bone marrow aspirates were collected from 296 patients at the time of surgery, and the presence of disseminated tumour cells was determined with the help of immunomagnetic selection (IMS) using the MOC31-antibody recognising EpCAM and with the help of standard immunocytochemistry (ICC) using the anti-cytokeratin (CK) antibodies AE1/AE3. RESULTS: Disseminated tumour cells were found in 152 of 252 (59%) bone marrow samples using IMS and in 25 of 234 (11%) samples using ICC. No association between the two detection methods was observed. The presence of EpCAM⺠cells was not associated with any clinicopathological parameters, whereas a higher frequency of CK⺠cells was found in patients with an advanced pT status. Disseminated tumour cells, as detected using IMS, had no prognostic impact. Patients with CK⺠cells in the bone marrow had a reduced relapse-free survival, but the difference was not statistically significant. CONCLUSION: Our findings do not support the further development of DTC detection for clinical use in early-stage NSCLC. Future studies should include the molecular characterisation of DTCs, along with an attempt to identify subpopulations of cells with biological and clinical significance.
Asunto(s)
Células de la Médula Ósea/metabolismo , Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Metástasis de la Neoplasia , Células Neoplásicas Circulantes , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales/inmunología , Antígenos de Neoplasias/inmunología , Células de la Médula Ósea/citología , Células de la Médula Ósea/inmunología , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Moléculas de Adhesión Celular/inmunología , Molécula de Adhesión Celular Epitelial , Femenino , Humanos , Queratinas/inmunología , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Resultado del TratamientoRESUMEN
The article describes the clinical case and analyzes the literature concerning endoprosthesis replacement in the case of traumatic thoracic aortic injury in polytrauma. Current strategy of diagnostics and treatment of patient in critical condition with rupture of isthmic aortic part is based on the principle of multistage surgical treatment (damage control orthopedic). The external fixation of multiple pelvis and extremities fractures and on-time implantation of stent-graft in thoracic aortic part were performed at first hours after the admission. A condition of the patient was stabilized. The delayed reconstructive operations on pelvis and extremities bones allowed obtaining the satisfactory functional result. The principles of staged surgical treatment and the use of on-time high-technology methods allowed saving life for the patient even in critical situation in I level traumatologic centre.
Asunto(s)
Aorta Torácica , Traumatismo Múltiple , Complicaciones Posoperatorias/terapia , Sepsis , Injerto Vascular , Heridas no Penetrantes , Adulto , Aorta Torácica/lesiones , Aorta Torácica/fisiopatología , Aorta Torácica/cirugía , Prótesis Vascular , Humanos , Masculino , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/fisiopatología , Reoperación , Rotura/diagnóstico , Rotura/etiología , Rotura/fisiopatología , Rotura/cirugía , Sepsis/etiología , Sepsis/terapia , Stents , Tomografía Computarizada por Rayos X , Índices de Gravedad del Trauma , Resultado del Tratamiento , Injerto Vascular/efectos adversos , Injerto Vascular/métodosRESUMEN
BACKGROUND: Pelvic radiation therapy is an important element of curative therapy for gynaecological cancers. Serious radiation-related complications developing months or years after treatment are known as late radiation tissue injury (LRTI). METHODS: We investigated the possible pain reducing effect of hyperbaric oxygen treatment (HBOT) in a study of 16 patients with LRTI after radiation for gynaecological malignancy. The 16 patients were registered prospectively, underwent HBOT for 21 consecutive days and were followed for a 6-month period after treatment using the Brief Pain Inventory, Montgomery and Aasberg Depression Rating Scale, as well as registration of global patient scores, analgesic consumption and magnetic resonance imaging (MRI) findings. RESULTS: HBOT was shown to have insignificant effect on pain, pain characteristics, daily function, the use of analgesics and MRI-related tissue injury. Fifty percent of the patients still reported some or good effect of the treatment. CONCLUSION: It is not possible to conclude from our study if gynaecological patients with pelvic pain will benefit from HBOT. The application of HBOT to selected patients may be justified, but further research with adequate sample size, as well as the timing of HBOT related to the development of LRTI, is required to establish the optimum patient selection.
Asunto(s)
Neoplasias de los Genitales Femeninos/radioterapia , Oxigenoterapia Hiperbárica/métodos , Dolor Pélvico/terapia , Traumatismos por Radiación/terapia , Actividades Cotidianas , Analgésicos/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/efectos adversos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Dolor Pélvico/etiología , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Traumatismos por Radiación/fisiopatología , Factores de TiempoRESUMEN
Results of treatment of 186 patients treated in the clinic in the period from 2000 through 2005 for infectious complications after severe combined injuries who underwent 264 operations have been studied. It was established that the endovideosurgical method of sanitation of the infection focus was used in 50% of cases at an average. The investigation of surgical treatment of infectious complications in patients with severe surgical pathology has shown high efficiency of endovideosurgical method for treatment of such complications in the third period of wound dystrophy. The proposed endovideosurgical methods of sanitation of the infection focus have a number of advantages over open ones--low traumatism, less number of postoperative infectious complications, less duration of the postoperative period.
Asunto(s)
Desbridamiento/métodos , Infección de la Herida Quirúrgica/cirugía , Cirugía Asistida por Video/métodos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The role of C-reactive protein (CRP) was studied in the development of nonbacterial systemic inflammation response, infectious complications, severe sepsis in severe combined trauma. It was shown that daily quantitative indicators of CRP in blood of patients in the intensive care unit allowed prognosis of the development of nonbacterial systemic inflammation response, infectious complications and sepsis. The CRP level >40 mg/l in the first day under conditions of not using glucocorticoids manifests a risk of the development of infectious complications. Prolonged reduction of CRP from the 3rd day is characteristic of a favorable course of trauma disease, maintenance of the level or its elevation - of pyo-infectious complications. With the following development of sepsis CRP in blood during the first week is higher than 120 mg/l. The nonbacterial systemic inflammation response is determined on the 2nd day after trauma in 14.8% of casualties not being followed by the development of septic complications and in 44.5% - followed by sepsis. Glucocorticoids and specific immune medicines used in treatment of sepsis result in a reduced amount or complete disappearance of CRP in blood during administration of these medicines. Rejection of them is followed by the appearance of CRP in the amount showing the effect of treatment. Gradual reduction of CRP in sepsis associated with decreased activity of the infectious processes was observed only in casualties without a polyorganic insufficiency.
Asunto(s)
Bacteriemia/epidemiología , Proteína C-Reactiva/metabolismo , Heridas y Lesiones/epidemiología , Heridas y Lesiones/metabolismo , Adulto , Bacteriemia/microbiología , Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/epidemiología , Lesiones Encefálicas/metabolismo , Femenino , Humanos , Masculino , Infecciones Neumocócicas/complicaciones , Infecciones Neumocócicas/epidemiología , Índice de Severidad de la Enfermedad , Choque Séptico/epidemiología , Heridas y Lesiones/diagnósticoRESUMEN
Basing on clinical experience of 212 surgically treated spinal tumours the authors present the principal problems in surgical treatment of neoplasmatic disease of the spine. The essential aim of surgical treatment is the tendency to the radical removal of the tumour and, in the same time, to achieve a good stabilization of the spine. The best method of stabilization of the spine is internal stabilization, transpedicular and interbody. The removed parts of the vertebral column should be replaced with bone grafts. The surgical treatment should be combined with oncological and rehabilitation.
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Vértebras Cervicales/patología , Vértebras Cervicales/cirugía , Linfoma/patología , Linfoma/cirugía , Plasmacitoma/patología , Plasmacitoma/cirugía , Sacro/patología , Sacro/cirugía , Neoplasias de la Columna Vertebral/patología , Neoplasias de la Columna Vertebral/cirugía , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Invasividad Neoplásica , Implantación de Prótesis , Costillas/trasplanteRESUMEN
It is known that regenerating axons emerging from the proximal stump of a transected nerve are attracted towards the distal stump. It is not certain whether this neurotropic effect is on the axons themselves or whether it is on supporting cells such as Schwann cells that the axons then follow. In order to investigate this question in rats, segments of the sciatic nerve were either isolated or removed and reinserted as grafts, and then sutured into the opposing ends of double-Y silicone tubes. In these tubes, a central conduit was formed by connecting the centrally facing limb of each Y tube. The nerve segments were sutured into one of the limbs at either end. The third limbs of the Y tubes formed side arms, one of which was left open; a plug of mobilised fatty connective tissue was sutured into the other. A gap of 6 mm was left between the cut ends and the fat pads (or openings from the side arms). After 2-3 wk a significantly greater outgrowth (P < 0.001) was found to link the nerve segments than to invade the side arms. The major cell component in the outgrowth was Schwann cells, supported by fibroblasts and capillaries and surrounded by a lamellated layer of flattened fibroblasts. The growth into the side arms had a looser cellular architecture and contained considerably fewer Schwann cells. The results strongly suggest the existence of mutual attraction between emigrant Schwann cells, or possibly endoneurial fibroblasts, from the 2 cut ends of transected nerves. This conclusion has implications for the guidance of axons across gaps in nerves. It does not exclude an additional neurotropic effect from the distal stump on axons.
Asunto(s)
Regeneración Nerviosa/fisiología , Células de Schwann/fisiología , Animales , Capilares/citología , Movimiento Celular/fisiología , Desnervación , Fibroblastos/fisiología , Fibroblastos/ultraestructura , Masculino , Microscopía Electrónica , Ratas , Ratas Sprague-Dawley , Células de Schwann/ultraestructura , Nervio Ciático/citología , Nervio Ciático/fisiología , Nervio Ciático/cirugíaRESUMEN
Observations have been made on the growth of regenerating axons from transected rat sciatic nerve through Y-shaped silicone tubes. When the distal stump of the nerve was sutured into 1 distal limb of the tube and a fat pad into the other, a clear preference for the axons to regenerate towards the distal stump was found. In other experiments regenerating axons from the peroneal or tibial divisions of the sciatic nerve were given the choice of growing towards either the peroneal or tibial nerves, each being inserted into 1 of the 2 distal limbs of the Y-tube. No significant preference of the proximal stump to regenerate towards its appropriate distal stump was detected. A neurotropic influence of the distal stump on the nerve has therefore been confirmed, but topographic specificity of regeneration at the level of the nerve trunk has not been established.
Asunto(s)
Regeneración Nerviosa , Nervio Ciático/crecimiento & desarrollo , Nervio Ciático/fisiología , Animales , Fibras Nerviosas Mielínicas/fisiología , Especificidad de Órganos , RatasRESUMEN
Feeding rats with galactose as 40% of their diet results in peripheral nerve oedema related to the intrafascicular accumulation of galactitol and sodium. In this study, associated changes in the perineurium were examined by the freeze-fracture replication technique. Perineurial cells are linked by tight junctions (zonulae occludentes). In normal animals these are made up of anastomosing strands organized in a belt-like arrangement along the margins of continuous cells. The majority of the tight junctions in the galactose-fed animals displayed structural abnormalities. These ranged from slight separation of the strands to fragmentation and dispersal, with looping of isolated strands. Some of the tight junctions contained large dilated compartments within the junctional network. Short lengths of intramembranous particles, probably representing assembly or disassembly of tight junctional strands, were also observed. The membranes of perineurial cells normally possess numerous openings of caveolae. A quantitative assessment showed that the mean density of these caveolae openings was increased in the galactose-fed rats as compared with controls. The alterations in the tight junctions resemble those that have been produced experimentally in epithelia by subjecting them to abnormal osmotic gradients. They also resemble those seen in human diabetic neuropathy in which osmotic disturbances involving the perineurium have been considered to occur. If the alterations involve the inner layers of the perineurium, they are likely to impair its barrier function. The increased number of caveolae openings in galactose neuropathy may represent a reaction to the endoneurial oedema and indicate that the pinocytotic-like vesicles have a transport function.
Asunto(s)
Edema/patología , Técnica de Fractura por Congelación , Galactosa , Uniones Intercelulares/patología , Enfermedades del Sistema Nervioso Periférico/patología , Animales , Membrana Celular/patología , Edema/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Ratas , Ratas EndogámicasRESUMEN
The plasma levels of FXII, prekallikrein (PK) and high- and low molecular weight kininogens (HK and LK) were measured in women on low estrogen dose (30-40 micrograms ethinylestradiol) oral contraceptives (OC) and in controls. FXIIa was assayed in acetone-treated citrated plasma (CPL) with PK and the tetrapeptide S-2222 as substrates, and in acetone-treated citrated plasma with benzamidine (BPL) with PK as substrate. The level of FXII was found to be about 20% higher in OC-plasma than in control plasma. Kallikrein was assayed in CPL with S-2222 as substrate and in BPL with the tripeptide S-2302 as substrate. No difference in PK-level was observed in the CPL-based method, whereas an increase in kallikrein activity of about 30% was registered in BPL. The levels of HK and LK were estimated both in rocket immunoassay and in bioassay of released kinin. No difference in HK-level could be registered in immunoassay, whereas the bioassay revealed a HK-level in OC-plasma of 40% of the control level. Immunoblot studies showed that a substantial part of HK in OC-plasma was present as kinin-free protein (mol. wt. 103 KD), assumed to possess a higher cofactor potency than that of native HK. Both in bioassay and immunoassay the level of LK was found to be 60% higher in OC-plasma than in control plasma. Considered together the observations on contact factors made in this study provide support for the assumption of an increased readiness for contact activation in plasma from women using OC.