Mast Cells Might Have a Protective Role against the Development of Calcification and Hyalinisation in Severe Aortic Valve Stenosis.

Aortic valve stenosis is characterized by inflammation and extracellular matrix remodelling. The aim of this study was to analyse the impact of mast cells on the occurrence of histopathological changes of aortic valves in patients with severe grade, non-rheumatic degenerative aortic valve stenosis. Valve specimens were obtained from 38 patients undergoing valve replacement. The role of mast cells was analysed by dividing the specimens into two groups, characterized by the presence (group A, N = 13) or absence of mast cells (group B, N = 25). There were no significant differences in clinical data between the two groups. In group A, T cells and macrophages were present in all aortic valves, as compared to a significantly lower proportion of valves with T cells and macrophages in group B. Valves in group A were less often calcified and hyaline-degenerated than valves in group B. There were no changes in fibrosis between the two groups. We found a positive correlation between the presence of mast cells and macrophages/T cells, a negative correlation between the presence of mast cells and calcification/ hyaline degeneration, and no correlation between the presence of mast cells and fibrosis. There was also a negative correlation between the presence of macrophages/T cells and calcification. The linear regression model identified only the presence of mast cells as an independent negative prediction value for calcification. In conclusion, mast cells might have a protective role against the development of calcification and hyaline degeneration in severe grade, non-rheumatic aortic valve stenosis.

Prognostic value of skin histology in GVHD after intestinal transplantation.

Intestinal transplantation (Itx) is increasingly being performed to treat patients with irreversible intestinal failure. Acute graft-versus-host disease (GVHD) after Itx is a life-threatening complication which can progress to organ failure, systemic complications and death. The purpose of this study was to assess the diagnostic and prognostic role of histological changes as demonstrated by skin biopsy for acute GVHD after Itx. A porcine model of orthotropic Itx and bone marrow transplantation with tacrolimus-based immunosuppression was used to assess any correlation between acute graft cellular rejection and skin histological findings for the prediction of GVHD. Skin and small intestinal biopsies were histologically assessed on postoperative days 0, 15, 30, 45, and 60 and analyzed and classified as grade 1 to 4. A linear correlation was observed between the histological grading values of skin biopsy changes and the histological grading values of small intestinal biopsy changes (Kendall's tau_b was 0.855 for the Itx group and 0.730 for the Itx BM group. In conclusion, our findings emphasize the diagnostic and prognostic value of skin biopsy analysis for acute GVHD after Itx.

Skin biopsies predict acute graft-versus-host disease after small bowel transplantation in pigs.

Intestinal transplantation is being increasingly performed to treat patients with irreversible intestinal failure. The major cause of intestinal graft failure is graft-versus-host disease (GVHD) that represents a life-threatening complication after small bowel transplantation (Itx). The purpose of this study was to assess the diagnostic and prognostic value of skin biopsy histological changes for acute GVHD after Itx in pigs. Thirty-four Large White pigs were divided into three groups: Group 1 with Itx only, Group 2 with Itx and donor bone marrow infusion (Itx BM) and Group 3 (control group - before the operation). Animals received tacrolimus-based immunosuppression from day 0 to day 30 postoperatively. Skin and small bowel biopsies were histologically assessed, analysed and classified from grade 1 to 4 on postoperative days 15, 30, 45 and 60. There was a strong correlation between the histological grading values of skin biopsy changes and the histological grading values of small bowel biopsy changes (Kendall's tau_b is 0.855 for the Itx group and 0.730 for the Itx BM group). The significant correlation found between skin and small bowel histological changes suggests the prognostic value of skin biopsies after Itx. In conclusion, our findings emphasise the diagnostic and prognostic value of skin biopsy analysis for acute GVHD after Itx.

Hepatobiliary cystadenoma can protrude and grow into the bile ducts.

BACKGROUND/AIMS: To evaluate the phenomenon and the potential reasons for protrusion and growth of hepatobiliary cystadenoma into the extrahepatic bile ducts in our patients, accomplished by a review of the data regarding hepatobiliary cystadenomas published elsewhere. METHODOLOGY: In a retrospective open study conducted over the last eight years, five patients with hepatobiliary cystadenoma and one patient with hepatobiliary cystadenocarcinoma were operated on. All the patients were females aged between 25 to 61 years. Diagnostic procedures, laboratory, operative and histopathological findings and treatment were evaluated. RESULTS: Most of our patients were found to have hepatobiliary cystadenoma located in the left surgical liver. In three out of five patients with HBC mesenchymal stroma was histologically detected. In two of the three, protrusion and growth into the extrahepatic bile ducts was found. CONCLUSION: Considering the pathogenesis, location and the morphology of HBC, the mesenchymal stroma may present the competent potential for intraductal progression of the tumor. Radical excision should be performed for successful treatment of hepatobiliary cystadenomas, because of the potential for reoccurrence.

Colon mucosal cells after combined radiotherapy and chemotherapy.

The aim of this study was to investigate early histological and stereological changes in enterocytes, lymphocytes, mast cells, serotonin- and somatostatin-secreting cells in colon mucosa the first day after the end of combined radiotherapy and chemotherapy. For experimental model 20 Beagle dogs were used. Ten dogs were given platinol every 5 days over 20 days and they were irradiated 20 days with 32 Gy (every second day with a fractional dose of 3.2 Gy) onto the whole pelvis and tail. Another 10 dogs represented a control group. For detection of apoptosis the TUNEL technique was used, whereas immunohistochemical methods were performed for detection of somatostatin- and serotonin-secreting cells, and for proliferating cell nuclear antigen in epithelial cells. The volume density of enterocytes in apoptosis was increased, and Vv of paracrine cells (mast cells, somatostatin and serotonin positive cells) was significantly increased in the treated group compared to the control group. In the treated group a significantly lower Vv of lymphocytes and PCNA-positive enterocytes was shown compared to the control group. The results of our experiments showed that combined radiotherapy and chemotherapy caused loss of enterocytes and lymphocytes early after the therapy. It was associated with an increased volume density of paracrine cells. These morphological changes in the colon mucosa might be the earliest changes leading to disruption of the mucosal barrier, malabsoption syndrome, stenosis, inflammation and other complications resulting from the radiotherapy and chemotherapy.

Polymorphisms +45T>G and +276G>T of the adiponectin gene does not affect plasma adiponectin level and carotid intima-media thickness in patients with diabetes mellitus type 2.

AIM: Despite increasing evidence of adiponectin's anti-inflammatory and antiatherogenic effects, its role in atherogenesis remains uncertain. The aim of the present study is to investigate the association between +45T>G and +276G>T polymorphisms of the adiponectin gene and both plasma adiponectin levels and carotid intima-media thickness in patients with diabetes mellitus type 2. METHODS: 301 diabetic patients, divided into three categories on the basis on BMI were enrolled in the study. Carotid intima-media thickness (CIMT) was assessed ultrasonographically. Plasma adiponectin levels were measured by enzyme-linked immunosorbent assay (ELISA). Genotypes were determined by real-time PCR. RESULTS: Adiponectin level and prevalence of the G allele of 45T>G polymorphism decreased significantly with increasing BMI category. G allele of +45T>G polymorphism was associated with higher plasma adiponectin level only after adjustment for age, sex and BMI. No statistically significant difference in CIMT and +276T>G genotypes distribution was observed between BMI categories. None of the polymorphisms as well as plasma adiponectin level was associated with CIMT after adjustment for covariates. CONCLUSION: The G allele of the +45T>G polymorphism is not independently associated with plasma adiponectin level and is not associated with CIMT. +276G>T polymorphism is not associated with plasma adiponectin levels and CIMT in diabetic patients.

Assessment of liver regeneration by quantitative MRI analysis.

Liver regeneration after an extensive liver resection is a serious clinical problem, which is difficult to study in detail on patients. Therefore animal models were developed to study liver regeneration. Anabolic processes in the liver were assessed by measurements of the cholinesterase synthesis, and the regeneration of liver mass was monitored by use of magnetic resonance imaging. It has been shown that the liver mass reaches 90% of the control within the first week after the resection of 75% of the liver. This is partly due to the regeneration, and partly to the increased water content of the regenerated liver, shown by the magnetic resonance images. The results allow the conclusion that the magnetic resonance imaging is a reliable method to assess liver regeneration in vivo.

Percutaneous drainage of pancreatic pseudocyst into the stomach.

BACKGROUND: We present our experience with percutaneous ultrasonographically guided internal cystogastric drainage of pancreatic pseudocysts using a double pigtail catheter. METHODS: In nine patients, the pancreatic pseudocysts following acute pancreatitis were drained percutaneously into the stomach with the double pigtail catheter under ultrasonographical (US) control. The needle insertion through both gastric walls and the final position of the proximal curve of the catheter were monitored with a gastroscope. The position of the distal curve of the catheter was checked by US. There were no procedure-related complications. The patients were followed up monthly by clinical and US examination. RESULTS: At first follow-up 1 month after the intervention, none of the patients had evidence of the pseudocyst. The patients were not aware of the catheter and functioned normally throughout the procedure and catheter removal. The catheter was removed endoscopically after 5-8 months. CONCLUSIONS: The method is minimally invasive and also feasible in high-risk surgical patients. It requires a team consisting of an interventional radiologist, an ultrasonographer, and an endoscopist. In properly selected patients, the results are excellent.

An unusual complication after percutaneous drainage of a pancreatic pseudocyst into the stomach.

In the period between September 1995 and June 1999, we performed percutaneous drainage into the stomach in 12 patients. There were no complications or pseudocyst recurrences on insertion or after endoscopic removal of the catheter, which was left in site for 1 year on average. After endoscopic removal of the drainage catheter, one of the patients presented with a cystic formation in the stomach wall, which caused stomach emptying disorder. Therefore, the patient had to be reoperated. The cyst wall was incised and a part of the cystic wall sampled for histological examination. The cyst was then drained into the isolated Roux loop of the jejunum. Histological findings of the cystic wall specimen showed the presence of granulation tissue and smooth muscle layers with ganglia cells of myenteric nerve plexus. Despite this complication, we believe that percutaneous endoscopically and ultrasonographically guided drainage of pancreatic pseudocyst into the stomach by means of a double pigtail catheter is a good method that yields encouraging results in sonographically selected cases. The position of the drainage catheter needs to be checked endoscopically, and the catheter should be removed only after 1 year.