Systemic alterations in concentrations and distribution of plasma phospholipids in prostate cancer patients.

The relationship between plasma levels of total phospholipids (PL) and/or PL fractions and neoplastic diseases are not fully understood. Therefore, the aim of this study was to analyze concentrations and distribution of plasma phospholipids in patients with prostate cancer (PCa) related to the Gleason score, clinical stage and pathologic grade of prostate cancer. We analyzed plasma phospholipids in 57 newly diagnosed, untreated PCa patients and in 43 age-matched healthy male subjects. Significantly lower (P < 0.01) levels of total plasma PL and all PL classes were found in PCa patients when compared with healthy subjects. The relative concentrations of PL fractions were also changed. Further decrease of total PL and PL fractions was found related to an increase of clinical stadium, pathologic grade, and Gleason score, with phosphatidylethanolamine as the most sensitive plasma PL, the level of which significantly decreased even at the first stage of PCa. Our results showed an altered plasma PL profile in PCa patients, which may contribute to monitoring of the disease progression.

Bilateral ureteral obstruction due to primary myelofibrosis caused hyperuricaemia.

In healthy population, uric acid comprises the major component of 10-20% of renal stones. Extreme hiperuricaemia is seen in cancer patients with tumour lysis syndrome (TLS) which is classically associated with haematological malignancies with rapid tumour growth rates such as acute lymphoid leukaemia and high grade lymphomas. Primary melofibrosis (Agnogenic myeloid metaplasia-AMM) is a chronic myeloproliferative disease characterized by splenomegaly, a leukoerythroblastic blood picture, teardrop poikilocytosis and varying degrees of marrow fibrosis. Due to the increased extramedullary haematopoiesis, hiperuricemia may occur. However, TLS in patients with AMM is, according to the available literature, described just in one patient. In this paper we present a case of a 47-year-old male patient who was admitted to the hospital with symptoms of fatigue and small amount of urine, and clinical signs of plethora and enlarged spleen. The laboratory findings showed leuko-and erythrocytosis, increased levels of urea-BUN (32 mmol/l) and creatinine (766 mmol/l) as well as uric acid (920 mmol/l). The immediate abdominal ultrasound confirmed extreme splenomegaly, but also showed bilateral hydronephrosis of grade II-III with two stones in proximal part of right ureter and one in proximal part of left ureter as well as empty bladder. Stones were not seen on plain film. Since the patient was in complete anuria, with further rapid elevation of BUN and creatinine levels, bilateral ureteral stents were applicated together with extensive hydration, urine alkalization and administration of allopurinol which resulted in the complete recovery of kidney function. The bone marrow biopsy was also performed and histopathological diagnosis was: Hypercellulary phase of AMM.

Lipid profile as a prognostic factor in cancer patients.

PURPOSE: The relationship between plasma lipid levels and neoplastic diseases is still unclear. The aim of this study was to analyse the lipid profile of individuals with non-Hodgkin's lymphoma (NHL) or prostate carcinoma (CaP) and to follow serum lipid levels changes in NHL patients according to their response to chemotherapy. PATIENTS AND METHODS: Forty-seven patients with NHL, 57 patients with CaP, two control groups composed of 29 and 43 age- and sex-matched healthy adults, related to NHL and CaP patients, respectively, were included in the study. Follow-up studies of NHL patients were carried out after the 3rd and 6th cycle of chemotherapy. RESULTS: Initial plasma cholesterol (Chol), HDL-cholesterol (HDL-Chol) and phospholipids (PL) values were significantly lower in patients with NHL or CaP than in controls. Following chemotherapy, we noticed a progressive increase in lipid levels in NHL patients with complete remission (CR) and stable disease (SD), and further decrease in patients with the disease progression. CONCLUSION: Decreased plasma Chol, HDL-Chol and PL levels of patients with NHL or CaP can be considered as non-specific prognostic parameters in patients with these malignancies.

[Urethral syndrome in men--chronic pelvic pain syndrome].

INTRODUCTION: Chronic pelvic pain syndrome (CPPS) is defined as pelvis minor pain of nonmalignant nature repeating in different time intervals. Urethral syndrome (US) represents a most poorly defined entity within CPPS. OBJECTIVE: The estimation of US influence on quality-of-life as well as the determination of the way of treatment and therapy optimal length. MATERIAL AND METHODS: A prospective one-year study included 166 men with CPPS, median age of 54 years; they were monitored clinically. During the patient monitoring the NIH-CPSI questionnaire (National Institute of Health-Chronic Prostatis Symptom Index) was used. US was diagnosed in 79 patients (47%), and according to the most intensive pain localization they were divided into three groups. All the patients were treated with alpha adrenergic blockers and non-steroidal anti-inflammatory drugs, and the treatment of the patients with positive urethral smear also included antibiotherapy. The values of total NIH-CPSI, as well as of its individual components were analyzed after three and six months of treatment. RESULTS AND DISCUSSION: The therapy application had a significant influence on the decrease of total NIH-CPSI--23.3% (p < 0.01), pain symptoms (p < 0.0) and urinary difficulties (p < 0.01), and the point values of quality-of-life score were diminished by 0.7 to 1.9 points depending on the group of those monitored (p < 0.01). CONCLUSION: Our study indicated a significant influence of CPPS on quality-of-life and a necessity of a serious approach to patients and their treatment.

Paraneoplastic bleeding disorder due to isolated hypofibrinogenemia: a case report.

An 80 years old male patient was admitted in our hospital with massive haematomas in the left forearm, chest and abdominal wall accompanied by intense back pain symptoms. Laboratory evaluation showed anemia, mild thrombocytopenia and elevated lactate dehydrogenase and alkaline phosphatase levels and normal concentrations of all the other biochemical parameters. Study of the coagulation status demonstrated prolonged thrombin time (TT), low fibrinogen levels--0.98 g/l while plasminogen, antithrombin III (AT III) and protein C levels were found to be within normal range. Computed tomography scans of the head, chest and abdomen showed an enlarged infiltrative prostate, osteolytic bone lesions in vertebras L5-S1 and a large haematoma of the abdominal wall as the only pathologic findings. Very high levels of the prostate specific antigen indicated the possible existence of a prostate carcinoma with metastases to the vertebral column that resulted in elevated alkaline phosphate and lactate dehydrogenase levels. There were no signs of liver involvement and impaired hepatic synthetic function. Based on the results of the laboratory tests we concluded that the cause of the bleeding disorder in our patient was an acquired hypofibrinogenemia, which is a very rare paraneoplastic phenomenon. The patient was treated with daily transfusions of cryoprecipitate with no long-term improvement. Then the specific anti-tumor therapy (ciproteron acetate) was initiated, and two weeks later, fibrinogen concentration and TT returned to normal values.

The relaxant effect of vasoactive intestinal polypeptide in the isolated canine uterine artery: the role of endothelium.

The purpose of this study was to examine the effect of vasoactive intestinal polypeptide (VIP) on the uterine artery obtained from non-pregnant dogs. VIP (3 x 10(-9)-3 x 10(-7) M) induced concentration-dependent relaxation in canine uterine arteries with intact endothelium, pre-contracted with 10(-5) M phenylephrine (pEC(50) = 7.52 +/- 0.02, maximal response was 82.19 +/- 2.15%, n = 36). The administration of the cyclooxygenase inhibitor indomethacin (10(-5) M) or 4-aminopyridine (4-AP), a blocker of potassium channels (10(-5) M), did not modify the relaxation induced by VIP. Contrary to this, N(G)-nitro-L-arginine (L-NOARG) (10(-5) M) inhibited relaxation is evoked by VIP. Indomethacin applied with L-NOARG did not provoke further inhibition of VIP-induced relaxation. In the presence of both L-NOARG and L-NOARG + indomethacin, 4-AP led to the further inhibition of VIP-induced relaxation of canine uterine artery. It is concluded that VIP induces endothelium-dependent relaxation of uterine arteries of non-pregnant dogs, which can be entirely explained by the production of nitric oxide (NO) from the endothelial cells. We proposed that when NO synthesis is inhibited, VIP induces further relaxation, independent of the edothelium-derived relaxing factors, probably through activation of K(+) channels.

Endothelium-dependent relaxation of canine uterine artery in response to acetylcholine: the possible involvement of alternative pathways.

The effect of acetylcholine on the isolated, pre-contracted, uterine artery of non-pregnant dog was investigated. Acetylcholine-induced concentration-dependent relaxation of isolated canine uterine artery with endothelium (pEC50 = 6.48 +/-0.01, n = 37) and was without effect on arterial segments denuded of endothelium. Indomethacin, 4-aminopyridine (10-5 m) and pre-contraction with K+-rich Krebs-Ringer bicarbonate solution had no effect on acetylcholine-induced relaxation. NG-nitro-l-arginine (l-NOARG) (10-5 m) inhibited relaxation evoked by acetylcholine. Indomethacin applied with l-NOARG led to further inhibition of acetylcholine-induced relaxation. In the presence of both l-NOARG and indomethacin, 4-aminopiridine did not provoke further inhibition of acetylcholine-induced relaxation of canine uterine artery. It is concluded that the acetylcholine-induced relaxation of canine uterine artery is probably mediated by endothelial production of nitric oxide (NO). However, if NO-synthase is inhibited, acetylcholine-induced vasorelaxation may be, in part, mediated through activation of cyclooxygenase pathway.

[Use of fibrin glue in the prevention of leakage in pancreatico-jejunal anastomoses]. / Primena fibrinskog lepka u prevenciji popustanja pankreasno-jejunalne anastomoze.

The aim of this study was to test the protective effects of fibrin sealing on the pancreatico-jejunostomy (PJA), the high-risk anastomosis following pancreas head resection. Experimental study was performed on the mongrel dogs, divided in two groups (20 animals each): Experimental group-with end to end "dunking" PJA, protected by temporary occlusion of the pancreatic duct with fibrin sealant/Tissucol/Immuno Ag/, while control group was without any protective procedure. The animals were followed 5 months in order to study: protective effects of such procedure on the PJA quantified with the percent of anastomotic leakage, effects of the exocrine secretion and effects the endocrine function Results: PJA leakage occurred in 13.33% in control group. No leakage was registered in experimental group. Biochemical, histological and electron microscopic study showed slight transitory elevation of amylase levels. Fibrin glue plug was dissolved and pancreatic juice output was reestablished 12th days postoperatively. Long term follow-up showed no damages of the endocrine and exocrine pancreas. Pancreatic duct occlusion with fibrin glue appeared to be an useful method in the prevention of pancreatico-jejunostomy leakage, without negative effects on the exocrine and endocrine pancreas.

[Partial resection of the liver in the treatment of echinococcosis]. / Iskustva sa parcijalnim resekcijama jetre u lecenju ehinokokusa.

On the basis of reports' reviewed and authors' experience, in 118 patients with hydatid disease of the liver, 15 of whom (12%) have been treated by partial resection of the liver, it can be concluded that: - Partial resections of the liver represents a radical surgical procedure in the treatment of liver hydatidosis, - A surgical treatment of the liver hydatid disease requires a total extirpations of echinococcus cysts, as well as irreversibly damaged liver tissue itself, - These resections' methods should be carried out in definite indications, - In comparison with other, especially more conservative (surgical) procedures, resections reduce complications and shorten a hospitalization, - Because of technical difficulties concerning respective surgical procedures (in particular left or right lobectomy), one should always have in mind the relative benignity of the hydatid disease, operative risk, and that other less aggressive surgical methods exist. - Surgical departments applying these methods have to employ sufficient quantity of adequate blood, well trained and experienced surgeons and equipment.