RESUMEN
BACKGROUND: Patients with metastatic colorectal cancer receive chemotherapy prior liver resection more and more frequently. Histopathologic assessment methods of the resected specimen could evaluate the response to chemotherapy. In this study it is analyzed if these histopathologic changes are specific to preoperative chemotherapy and if these methods have correlation with survival. METHODS: Sixty three patients with available pathology slides, resected for colorectal cancer liver metastases were enrolled in this study. 46 patients (73%) received neoadjuvant chemotherapy. Five pathological evaluation methods were compared according to the literature: [1] residual tumor cell ratio, [2] tumor regression grade (TRG) scoring system, [3] modified tumor regression grade (mTRG) scoring system with the type of necrosis, [4] pattern of tumor regression and [5] the tumor thickness at the tumor-normal interface (TNI). RESULTS: Analyzing the pathological methods between the chemotherapy (CTX) and the non-chemotherapy group (NC), we found that that four evaluation methods showed significant and one showed strong correlation with the use of chemotherapy. (Residual tumor cell ratio: p = 0.08; TRG: p <0.01; mTRG: p = 0.03; pattern of tumor regression: p <0.01; TNI: p = 0.02). In the chemotherapy group none of the analyzed pathological methods showed significant correlation with progression free survival (PFS) or with overall survival (OS). Residual tumor cell ratio, TRG and the pattern of tumor cells showed positive but not significant correlation with OS and PFS and a slight difference in the group of patients with TNI <2 mm could be documented. CONCLUSIONS: Tumor regression grade (TRG) and tumor thickness at the tumor-normal interface (TNI) were the most useful methods for pathological response evaluation and these methods had some correlation with survival. According to these data, authors concluded, that a reproducible and well defined scoring system, based on different histopathological evaluation methods should be developed to predict more accurately the effect of neoadjuvant chemotherapy in CRCLM patients.
Asunto(s)
Neoplasias Colorrectales/patología , Neoplasias Hepáticas/patología , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Quimioterapia Adyuvante/métodos , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/cirugía , Supervivencia sin Enfermedad , Hepatectomía/métodos , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/secundario , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
The aim of the present study was to analyse the preoperative platelet count and the platelet-lymphocyte ratio (PLR) in patients with colorectal cancer (CRC) of different stages and with hepatic metastasis of CRC (mCRC) and to compare these factors as potential prognostic markers. Clinicopathological data of 10 years were collected retrospectively from 336 patients with CRC and 118 patients with mCRC. Both in the CRC and the mCRC group overall survival (OS) was significantly worse in patients who had elevated platelet count (hazard ratio [HR] = 2.2, p < 0.001 and HR = 2.9, p = 0.018, respectively). Multivariate analysis indicated that elevated platelet count was an independent prognostic factor of CRC (HR = 1.7, p = 0.035) and mCRC (HR = 3.1, p = 0.017). Disease-free survival (DFS) was significantly worse in patients with elevated platelet count in the CRC group (HR = 2.0, p = 0.011). In the multivariate analysis the PLR was not a prognostic factor in either of the two cohorts (HR = 0.92, p < 0.001 and HR = 0.89, p = 0.789, respectively). The platelet count is a valuable prognostic marker for the survival in patients both with CRC and mCRC while the PLR is not prognostic in either group.
Asunto(s)
Plaquetas/fisiología , Carcinoma/diagnóstico , Neoplasias Colorrectales/diagnóstico , Neoplasias Hepáticas/diagnóstico , Trombocitosis/diagnóstico , Anciano , Biomarcadores de Tumor/metabolismo , Carcinoma/mortalidad , Carcinoma/secundario , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Femenino , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/secundario , Linfocitos/fisiología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Activación Plaquetaria , Recuento de Plaquetas , Pronóstico , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
Patients with metastatic colorectal cancer receive chemotherapy prior liver resection more and more frequently. This preoperative treatment has many effects which have to be analysed, like the safety of liver resection, toxicity, tissue regeneration, radiological and pathological response and survival data. The aim of the study was to evaluate the safety of bevacizumab containing preoperative chemotherapy and functional recovery of the liver after resection for colorectal liver metastases (CLM) and to analyse radiological and pathological data. Data of three groups of 120 consecutive patients-(1) CTX + BV: cytotoxic chemotherapy + bevacizumab, (2) CTX: cytotoxic chemotherapy, (3) NC: no treatment before liver resection-were analysed. Postoperative liver function and complications were compared, clinical, radiological and pathological data were evaluated. Between 01.12.2006 and 31.12.2010 41 resections was performed after chemotherapy + bevacizumab (CTX + BV) and 27 resections was performed after preoperative chemotherapy without bevacizumab (CTX). There were 60 hepatic resections in this period without neoadjuvant treatment (NC). 8 patients had repeated resections. The postoperative complication rate was 40 % but there was no statistical difference between the groups (P = 0.72). Only the type of resection was associated with a significantly higher complication rate (p = 0.03). The subgroup of patients, who received irinotecan had a higher complication rate in the CTX group than in the BV + CTX group (55 % vs 41 %). Preoperative administration of bevacizumab was associated with higher peak postoperative AST, ALT levels but did not affect functional recovery of the liver. The RECIST system was not able to predict the outcome after chemotherapy in every patient and in many cases this system overestimated the effect of chemotherapy. On histopathological examination the presence of necrosis was not associated with chemotherapy or pathological response. Use of chemotherapy before hepatic resection of CLM was not associated with a significant increase in complication rates. The functional recovery of the liver was not affected by the preoperative administration of chemotherapy. The use of combined neoadjuvant chemotherapy is safe before hepatic resection.
Asunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Antineoplásicos/administración & dosificación , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , Análisis de Varianza , Inhibidores de la Angiogénesis/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Aspartato Aminotransferasas/sangre , Bevacizumab , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Neoplasias Colorrectales/enzimología , Femenino , Fluorouracilo/administración & dosificación , Histocitoquímica , Humanos , Leucovorina/administración & dosificación , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Resultado del TratamientoRESUMEN
Described here is the case of a patient with infective endocarditis in a prosthetic valve due to a Mycobacterium fortuitum-group organism. The patient was treated medically and had a favorable clinical response. This is only the second report of survival after Mycobacterium fortuitum-group endocarditis, and the first of survival without surgical intervention. The duration of treatment is not well defined for this patient, but life-long suppressive therapy will likely be required.
Asunto(s)
Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Prótesis Valvulares Cardíacas/microbiología , Infecciones por Mycobacterium/tratamiento farmacológico , Mycobacterium fortuitum/aislamiento & purificación , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/microbiología , Anciano , Amicacina/uso terapéutico , Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Humanos , Masculino , Meropenem , Infecciones por Mycobacterium/microbiología , Tienamicinas/uso terapéuticoRESUMEN
A 42-yr-old man with ulcerative colitis was admitted for investigation of prolonged fever associated with cholestatic liver tests. Endoscopic retrograde cholangiopancreatography demonstrated a normal biliary tree, and liver biopsy showed granulomata. A clinical diagnosis of drug-induced granulomatous hepatitis was established as the symptoms disappeared after cessation of mesalamine therapy and recurred on rechallenge. Although the differential diagnosis of fever and hepatitis in patients with inflammatory bowel disease is wide, in this case mesalamine is the most likely cause.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Mesalamina/efectos adversos , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Colitis Ulcerosa/tratamiento farmacológico , Granuloma/patología , Humanos , Masculino , Mesalamina/uso terapéuticoRESUMEN
AIMS: The aim of the study was to analyse the role of tumour necrosis factor-alpha (TNF-alpha) in insulin resistance and endothelial dysfunction in patients with different types of obesity. PATIENTS AND METHODS: Fasting serum TNF-alpha immunoreactive concentration (enzyme-linked immunosorbent assay, ELISA) and bioactivity (L929 cell cytotoxicity assay), endothelin-1 and C-peptide levels (radioimmunoassay, RIA) were measured in 15 patients with android- and 13 patients with gynoid-type obesity and 15 lean healthy controls with normal glucose tolerance and blood pressure. RESULTS: Significantly (P<0.01) higher TNF-alpha concentration (8.92 +/- 0.44 pg/ml) and bioactivity (3.12 +/- 0.48 U/ml) were found in patients with android obesity as compared to patients with gynoid obesity (7.01 +/- 0.30 pg/ml, 0.97 +/- 0.11 U/ml) and to the lean controls (6.88 +/- 0.26 pg/ml, 0.88 +/- 0.08 U/ml). Serum endothelin-1 (5.38 +/- 0.30 pg/ml) and C-peptide levels (4.82 +/- 0.71 ng/ml) were also significantly higher (P < 0.01) in patients with android-type obesity than in controls (3.89 +/- 0.43 pg/ml, 1.46 +/- 0.25 ng/ml, respectively). In patients with gynoid-type obesity, only the C-peptide levels proved to be significantly higher (2.84 +/- 0.29 ng/ ml). Endothelin-1 levels, although were found to be slightly higher, did not differ statistically from in controls (4.56 +/- 0.31 pg/ml). There were significant positive linear correlations only in patients with android-type obesity between TNF-alpha, body mass index (BMI), serum endothelin-1 and C-peptide levels. CONCLUSIONS: TNF-alpha may be one of the factors contributing to insulin resistance and vascular dysfunction in patients with android obesity.
Asunto(s)
Endotelio Vascular/fisiopatología , Resistencia a la Insulina , Obesidad/fisiopatología , Factor de Necrosis Tumoral alfa/metabolismo , Adulto , Índice de Masa Corporal , Péptido C/sangre , Estudios de Casos y Controles , Endotelina-1/sangre , Ensayo de Inmunoadsorción Enzimática , Humanos , Modelos Lineales , Obesidad/sangreAsunto(s)
Péptido C/sangre , Endotelina-1/sangre , Obesidad/sangre , Obesidad/clasificación , Factor de Necrosis Tumoral alfa/metabolismo , Adulto , Ensayo de Inmunoadsorción Enzimática , Ayuno , Femenino , Humanos , Masculino , Obesidad/fisiopatología , Periodo Posprandial , Radioinmunoensayo , Valores de Referencia , Factor de Necrosis Tumoral alfa/análisisAsunto(s)
Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus/sangre , Resistencia a la Insulina , Obesidad/sangre , Factor de Necrosis Tumoral alfa/metabolismo , Factores de Edad , Péptido C/sangre , Diabetes Mellitus/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Glucagón/sangre , Humanos , Masculino , Persona de Mediana Edad , Obesidad/fisiopatología , Valores de Referencia , Caracteres SexualesRESUMEN
The role of tumor necrosis factor (TNF)-alpha in the development of insulin resistance has repeatedly been emphasized in the past few years. The present paper summarizes the data (including the authors' observations as well) focusing on the potential role of TNF-alpha in the pathogenesis of obesity and non-insulin-dependent diabetes mellitus: alteration of insulin receptor function, lipid metabolism, expression of sulphonylurea receptors, all of them suggested to be related to the TNF-alpha. The potential clinical relevances are shortly reviewed.
Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Resistencia a la Insulina , Obesidad , Factor de Necrosis Tumoral alfa , Citocinas , Diabetes Mellitus/etiología , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Insulina/metabolismo , Secreción de InsulinaAsunto(s)
Diabetes Mellitus Tipo 1/inmunología , Diabetes Mellitus Tipo 2/inmunología , Interleucina-12/sangre , Adulto , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/fisiopatología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Retinopatía Diabética/sangre , Retinopatía Diabética/inmunología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de ReferenciaRESUMEN
The role of tumor necrosis factor-alpha in insulin resistance has been studied in 59 patients with Type 2 diabetes, 28 with android type obesity and 35 healthy lean controls. Immunoreactive concentrations and bioactivity of serum tumor necrosis factor-alpha have repeatedly been determined in 8 weeks intervals for 12 months, five times per patients, by using ELISA and L929 cell cytotoxicity bioassay. Significantly higher immunoreactive tumor necrosis factor-alpha concentrations and bioactivity have been found in both, the Type 2 diabetic and obese groups as compared to the healthy persons. Tumor necrosis factor-alpha concentrations and bioactivity have showed a significant positive linear correlation with the elevated basal serum C-peptide levels and body mass indexes in both groups of patients. According to these data the cytokine might play a role in insulin resistance in obesity as well in Type 2 diabetes.
Asunto(s)
Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus/sangre , Obesidad/sangre , Factor de Necrosis Tumoral alfa/metabolismo , Tejido Adiposo/anatomía & histología , Anciano , Biomarcadores/sangre , Índice de Masa Corporal , Péptido C/sangre , Diabetes Mellitus/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Glucagón/sangre , Humanos , Masculino , Persona de Mediana Edad , Obesidad/fisiopatología , Valores de Referencia , Factor de Necrosis Tumoral alfa/análisisRESUMEN
The first Hungarian MEN IIB (multiplex endocrine neoplasia) syndrome is reported with the short summary of the literature about the pathogenesis and diagnosis of medullary thyroid carcinoma, presenting 80% in sporadic, 20% in hereditary form. The appearance of the patients alone (marfanoid stature, bulky lips, and ganglioneuromatosis of the tongue) may be almost enough for the presumption for the diagnosis of MEN IIB: For screening and preventing the clinical manifestation of the very aggressive medullary carcinoma in the relatives of the patient, the genetic screening is indispensable. The costs of the genetic screening and early treatment of the patients are much lower than the expenses of the traditional annual biochemical screening and the--delayed, often only supportive--treatment of the clinically manifested illness.
Asunto(s)
Neoplasia Endocrina Múltiple Tipo 2b , Neoplasias de la Tiroides/genética , Adolescente , Humanos , Masculino , Neoplasia Endocrina Múltiple Tipo 2b/diagnóstico por imagen , Neoplasia Endocrina Múltiple Tipo 2b/genética , Neoplasia Endocrina Múltiple Tipo 2b/patología , Neoplasia Endocrina Múltiple Tipo 2b/cirugía , Proto-Oncogenes , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , UltrasonografíaAsunto(s)
Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/diagnóstico por imagen , Endotelio Vascular/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Albuminuria/orina , Arteriosclerosis/diagnóstico por imagen , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Diabetes Mellitus Tipo 2/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Túnica Íntima/diagnóstico por imagen , Túnica Media/diagnóstico por imagen , UltrasonografíaRESUMEN
A sensitive, monoclonal antibody-based ELISA test was developed and used for quantitative determination of ochratoxin A (OA) in human sera. The measuring range of this test (without sample dilution) was 0.2-2.0 ng/mL, and the detection limit was 0.2 ng/mL. The OA concentrations of 355 sera samples varied from < 0.2 to 10 ng/mL OA, but 75% of the samples contained 0.2-1.0 ng/mL. This amount reflects a tolerable daily intake (TDI) value of toxin. However, in some cases (6.8%), more than 1.0 ng/mL OA was measured, which is probably a result of elevated intake of OA, which may even exceed the "virtually safe dose". Our data indicate that, like in many other countries, OA is present in food or feed products available in Hungary, and in order to save the health of consumers, their regular control is desirable.
Asunto(s)
Ensayo de Inmunoadsorción Enzimática/métodos , Micotoxinas/sangre , Ocratoxinas/sangre , Anticuerpos Monoclonales/análisis , Grano Comestible/química , Humanos , Hungría , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The role of the cytokines IL-1 alpha, IL-1 beta, and IL-6 and the cell adhesion molecules ICAM-1, LFA-1 (alpha and beta), and Mac-1 as accessory molecules for stimulation of T cells by the superantigen staphylococcal enterotoxin B (SEB) was examined. Both blood monocytes and alveolar macrophages were used as accessory cells because these cells differ in patterns of cytokine expression and thus potentially in accessory cell function for superantigens. The blastogenic response of highly purified T cells to SEB was reconstituted with either monocytes or alveolar macrophages. IL-1 secretion was increased comparably in monocytes and alveolar macrophages by SEB, but IL-6 was not stimulated by SEB. IL-1 alpha plus IL-1 beta reconstituted the response of T cells to SEB but required the addition of accessory cells. The cell adhesion molecules ICAM-1 and LFA-1 but not Mac-1 also functioned as accessory molecules for SEB-induced cluster formation and lymphocyte blastogenesis. Thus, not only must this superantigen bind to Class II MHC on accessory cells as is well known, but also SEB requires at least certain cytokines (IL-1 alpha and IL-1 beta) produced by accessory cells and cell adhesion molecules (ICAM-1 and LFA-1) for activation of T lymphocytes.
Asunto(s)
Células Presentadoras de Antígenos/inmunología , Enterotoxinas/farmacología , Activación de Linfocitos/inmunología , Macrófagos Alveolares/inmunología , Linfocitos T/inmunología , Adulto , Células Presentadoras de Antígenos/efectos de los fármacos , Moléculas de Adhesión Celular/inmunología , Humanos , Molécula 1 de Adhesión Intercelular , Interleucina-1/farmacología , Antígeno-1 Asociado a Función de Linfocito/inmunología , Macrófagos Alveolares/efectos de los fármacos , Monocitos/efectos de los fármacos , Monocitos/inmunología , Linfocitos T/efectos de los fármacosRESUMEN
A 16-year-old patient with Behçet's syndrome had massive hemoptysis due to a ruptured aneurysm of a segmental artery of the left lung. Emergency left lower lobectomy was performed. The patient is well 12 months after operation. There have been no further episodes of hemoptysis.
Asunto(s)
Aneurisma/complicaciones , Síndrome de Behçet/complicaciones , Hemoptisis/etiología , Arteria Pulmonar , Adolescente , Humanos , Masculino , Arteria Pulmonar/diagnóstico por imagen , Radiografía , Rotura EspontáneaRESUMEN
Cloxacillin-induced cholestasis was diagnosed with the help of the macrophage inhibition factor and mast-cell degranulation tests. The simultaneous occurrence of both immediate type as well as cell-mediated hypersensitivity to the drug suggested that a defect in the histamine-induced suppressor cells may underly this cloxacillin-induced allergic reaction.
Asunto(s)
Inhibición de Migración Celular , Colestasis/inducido químicamente , Cloxacilina/efectos adversos , Macrófagos/inmunología , Mastocitos/inmunología , Colestasis/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
In lymphoedema of the extremities arteriovenous shunt circulation develops. Regulation of limb circulation was studied in 28 cases of (primary and secondary) lymphoedema by using the venous isotope dilution method and technetium-macroaggregate perfusion scintigraphy. As a result of lymphoedema, limb circulation (total limb circulation) increases, arteriovenous O2 difference is low and the O2 uptake of the tissues is normal. The development of arteriovenous (micro-, and macro-) shunts can be directly visualized by perfusion scintigraphy. In lymphoedema of the extremities the nutritive--capillary--blood supply of the tissues remains normal and therefore, no trophic disturbances develop. Lymphoedema is often associated with a fairly considerable arteriovenous shunt circulation and, in such cases, the cardiac output as well as cardiac performance are enhanced.
Asunto(s)
Pierna/irrigación sanguínea , Linfedema/fisiopatología , Adulto , Gasto Cardíaco , Circulación Colateral , Femenino , Humanos , Pierna/diagnóstico por imagen , Linfedema/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Cintigrafía , Flujo Sanguíneo RegionalRESUMEN
The hemodynamic characteristics of peripheral lymphedema were studied in 28 patients with uni- or bilateral leg swelling. Leg blood flow was measured by venous isotope dilution (a technique for nutritive--capillary blood flow) and arteriovenous shunts were visualized by perfusion scintigraphy using radiolabelled macroaggregated albumin. Arteriovenous communications were uniformly detected in lymphedema, with a calculated "shunt flow" of 200 to 600 ml/min. Other features in the lymphedematous leg included an elevated limb blood flow rate and narrowed arteriovenous oxygen difference.