Liver macrophages contribute to pancreatic cancer-related cachexia.

Cachexia is a devastating process especially in pancreatic cancer patients and contributes to their poor survival. We attempted to clarify the pathological and molecular changes that occur in the liver during the development of cachexia. Using immunohistochemistry we investigated the infiltration of inflammatory mononuclear cells in liver biopsies of pancreatic cancer patients with or without cachexia, and the potential relevance of the cells for the nutritional and inflammatory status. Additionally, these findings were compared with the patients' clinical parameters. We found a significantly higher amount of CD68 immunoreactive macrophages in liver cross sections of patients with pancreatic cancer and cachexia. The number of CD68-positive macrophages was significantly inversely correlated with the nutritional status. Additionally, in these CD68-positive areas a significant increase in IL-6 and IL-1 immunoreactive cells was localized. Moreover, we found significantly increased areas of CD68-positive macrophages in liver biopsies of patients with a more dedifferentiated (aggressive) grading of the tumor. In conclusion, these results suggest that a crucial interaction between the tumor, PBMCs, and the liver may play a central role in the development and regulation of cachexia. Furthermore, pancreatic cancer may be able to alter systemic organ function even without obvious metastatic disease.

Thoracoscopic repair of congenital diaphragmatic hernia in children.

Minimal invasive surgery (MIS) has been first proposed in case of delayed congenital diaphragmatic hernia (CDH). Since then, about 32 cases of thoracoscopic CDH approach in newborns have been published. Conditions of thoracoscopy are reviewed and enlightened with our preliminary series. The advantages of thoracoscopy versus a laparoscopic approach are detailed. Since 1999, all children presenting with CDH after the immediate neonatal period were offered a MIS approach. We started treating stable newborns suffering a CDH by thoracoscopic procedures in 2003. In cases of late presentations, 10 thoracoscopies and 1 laparoscopy were performed. Among them, 4 patients suffered from an incarcerated hernia. One conversion to a thoracotomy, 1 video-assisted thoracic surgery (VATS), and 2 conversions to laparoscopies were required for the reduction of hernia contents. In those last cases, the hernia defects were sutured, coming back to the thoracoscopic approach. Six newborns with neonatal diagnosis of CDH were primarily treated by thoracoscopy. Four procedures were completed without difficulty. The diaphragm was approximated with interrupted 2/0 nonabsorbable sutures. On the lateral part of the defect, in which there is a lack of diaphragm against the ribs, plegetted rib-anchoring stitches were used. A wide defect requiring a patch needed for conversion to a thoracotomy; in this case, we encountered a very rare pericardial defect and had difficulties in reducing the liver. In another case, we went to a VATS with a less than 2-cm opening to insert a Gore Tex patch, which was required. Thoracoscopy for delayed CDH repair seems to be easy and feasible with good results. A combined procedure with both thoracoscopy and laparoscopy has proven its usefulness in case of incarcerated hernia. Thoracoscopic CDH repair in newborns is not feasible in every case due to the patient's conditions. Criteria for eligibility need more cases to be evaluated. The advantages and disadvantages of thoracoscopy versus laparoscopy are reviewed. Nevertheless, the thoracoscopic approach seems easier.

Two-dimensional ultrastructural elements lead to three-dimensional reconstruction of protuberances on the cocoon membrane of the leech, Theromyzon tessulatum.

Protuberances on the cocoon surface of the leech, Theromyzon tessulatum, are roughly parallel rows of triangular prisms arranged equidistantly to each other on the outer surface of the cocoon membrane. The distance between neighboring protuberances is approximately 1.6 microm, the height approximately 0.5 microm and the semi-width approximately 0.3 microm. The fibrillar arrangement within the protuberance maintains some elements of the helicoids found within the cocoon membrane but a high proportion of large holes disrupt the symmetry of the protuberance ultrastructure. A procedure for 3D reconstruction of the protuberance using the complementarity between the paratangential and normal sections through the cocoon is presented. Our results demonstrate that the ultrastructure of protuberances show elements of a twisted fibrillar arrangement, but the demands of filling a narrow space ruled by acute angles appears to cause a high degree of ultrastructural disorganization.

Ultrastructural properties of the Theromyzon (Annelida: Hirudinae) cocoon membrane.

The cocoon of the leech Theromyzon trizonare consists of fibrils packed into an arrangement that produces both C- and S-like patterns of bow-shaped lines in sections oblique through the membrane. Sections normal to the cocoon membrane show layers containing cross-sections of fibrils (approximately 16 nm dia.) that are separated by a center-to-center distance of approximately 23 nm. In cross-section, each fibril presents a central hole approximately 5 nm in diameter. A structureless layer covers most of the exterior surface of the cocoon membrane, and short protuberances are apparent in some zones.