Influence of sera from interstitial lung disease patients on angiogenic activity of mononuclear cells.

Chronic inflammation stimulates of neovascularization. The aim of this study was to evaluate the effect of sera from interstitial lung diseases (ILD) patients on angiogenic capabilities of different subsets of mononuclear cells. Serum samples were obtained from 22 patients with sarcoidosis, 20 with hypersensitivity pneumonitis, 20 with idiopathic pulmonary fibrosis, 9 with systemic sclerosis, 6 with pulmonary Langerhans cells histiocytosis, and from 20 healthy volunteers. Animal model of leukocyte induced angiogenesis assay was used as an angiogenic test. The pattern of angiogenic reaction was different in different diseases. Sera from systemic sclerosis and pulmonary Langerhans cells histiocytosis patients exerted inhibitory effects on angiogenesis, but sera from sarcoidosis, hypersensitivity pneumonitis, and idiopathic pulmonary fibrosis patients stimulated angiogenesis. Sera from sarcoidosis and pulmonary Langerhans cells histiocytosis primed monocytes for the production of angiogenic factors. The number of microvessels created after incubation of mononuclear cells depleted of monocytes with sera from systemic sclerosis patients significantly decreased. We conclude that the role of monocytes in the modulation of angiogenesis varies depending on the type of ILD. Sera from sarcoidosis stimulate and from pulmonary Langerhans cells histiocytosis patients inhibit neovascularization induced by monocyte mediators. Sera from systemic sclerosis inhibit angiogenesis induced by lymphocyte products.

Angiogenic activity of sera from interstitial lung disease patients in relation to angiotensin-converting enzyme activity.

The role of angiogenesis in the pathogenesis of interstitial lung diseases (ILD) is unknown. Angiotensin-converting enzyme (ACE) is a marker of sarcoidosis activity and may modulate angiogenesis. The aim of this study was to examine the relationship between ACE activity in ILD patients' sera and their effect on microvessels formation in an in vivo model of leukocyte-induced angiogenesis. The study population consisted of 77 sarcoidosis patients, 22 idiopathic pulmonary fibrosis patients, 16 bird fanciers lung patients, eight silicosis patients and 14 healthy donors. Serum ACE activity was assayed by spectrophotometric method. As an angiogenic test, a leukocyte-induced angiogenesis assay in an animal model was used. Sera from interstitial lung disease patients significantly stimulated angiogenic activity of mononuclear cells compared with healthy donors (p < 0.001). The highest ACE serum activity was measured in sera from the silicosis patients, and lowest in sera from the sarcoidosis and IPF patients. A significantly lower serum ACE activity was detected in the bird fanciers lung patients. Serum angiogenic activity of ILD patients measured by angiogenesis index negatively correlated with ACE serum activity (r = ;-0.52; p < 0.01). This correlation was highest in the sarcoidosis group (r = -0.6; p < ). Sera from ILD patient constitute the source of factors modulating angiogenesis.

Anaesthesia for radiation therapy - Gliwice experience.

General anaesthesia is rarely applied during fractionated radiotherapy with the exception of unco-operative patients. We performed a retrospective study to inform our current practice in anaesthesia procedures for radiotherapy application in children, brachytherapy and intraoperative radiation. The records of anaesthetized radiotherapy patients between January 2000 and September 2005 were analyzed. We analysed demographic data, type and localisation of neoplasm , radiotherapy data, type of anaesthesia and anaesthesia - related complications. In order to provide safe and efficient anaesthesia outside the Department of Anaesthesiology, we designed a mobile anaesthesia workstation. In total we performed 739 anaesthesia procedures: 267 in 16 children, 321 in 284 brachytherapy patients, and 151 as a part of intraoperative radiotherapy. Children age ranged from 2 - 8 years (median 4.6). All were given midazolam and atropine, then thiopental or ketamine. Neither muscle relaxants, nor propofol were used. Brachytherapy patients underwent: spinal block in 190 cases, general anaesthesia in 115, and deep sedation in 16 cases. General anaesthesia was inducted by propofol, followed by etomidate, thiopental and fentanyl. For spinal block the patients were given hyperbaric bupivacaine and fentanyl. Deep sedation was performed with midazolam and fentanyl, and thiopental or propofol when needed. Intraoperative radiotherapy was applied immediately after breast conserving surgery. No serious complications in all 739 anaesthesia procedures occurred. In conclusion we demonstrated the feasibility and safety of anaesthesia applied in our radiotherapy patients. The custom designed mobile anaesthesia workstation allowed us to provide safe and efficient anaesthesia in any place outside the Department of Anaesthesiology.

Angiogenic activity of sera from interstitial lung disease patients in relation to pulmonary function.

OBJECTIVE: Chronic inflammation and fibrosis are characteristic of interstitial lung diseases (ILD) and are accompanied by neovascularisation. The aim of this study was to examine the relationship between the angiogenic activity of sera from ILD patients and pulmonary function tests. MATERIAL AND METHODS: Serum samples were obtained from 225 ILD patients: 83 with sarcoidosis, 31 with idiopathic pulmonary fibrosis, 29 with extrinsic allergic alveolitis, 16 with collagen vascular diseases, 13 with scleroderma with pulmonary manifestations (SCL), 14 with Wegener's granulomatosis (WG), 12 with silicosis, 12 with pulmonary Langerhans cells histiocytosis, 10 with drug-induced pulmonary fibrosis, 5 with cryptogenic organizing pneumonia, and 36 healthy volunteers. An animal model of leukocyte induced angiogenesis assay was used as an angiogenic test. In all patients spirometry, whole body plethysmography, static lung compliance, and single breath diffusing capacity of the lungs for carbon monoxide (DLco) were performed. RESULTS: The angiogenic properties of sera from ILD differed, depending on the disease. In the examined ILD, the most important functional disturbances were decreases in static compliance and DLco. The correlation between DLco and angiogenic activity of sera was observed (P<0.05). CONCLUSIONS: The data show that sera from ILD patients constitute a source of mediators modulating angiogenesis. Angiogenic activity of sera of ILD patients is related to DLco.

Angiogenic activity of sera from interstitial lung disease patients in relation to clinical and radiological changes.

OBJECTIVE: Clinical symptoms and radiological changes are useful in monitoring patients with interstitial lung diseases (ILD). Neovascularization participates in the pathogenesis of idiopathic pulmonary fibrosis and other ILD. The objective of the study was to examine the relationships between angiogenic activity of sera from ILD patients and clinical or radiological status. MATERIAL AND METHODS: Serum samples were obtained from 83 patients with sarcoidosis, 31 with idiopathic pulmonary fibrosis (IPF), 29 with hypersensitivity pneumonitis (HP), 16 with collagen diseases with pulmonary manifestation (CD), 13 with scleroderma (SCL), 14 with Wegener's granulomatosis (WG), 12 with pulmonary Langerhans cell histiocytosis (HIS), 12 with pneumoconiosis (PNC), 10 with drug-induced lung disease (DLD), 5 with cryptogenic organizing pneumonia (COP), and from 36 healthy volunteers. As an angiogenic test we used a cutaneous angiogenesis assay according to Sidky and Auerbach. Clinical status was evaluated using a special questionnaire. In all patients chest radiographs were performed. RESULTS: The angiogenic properties of sera from ILD differed depending on the clinical diagnosis. The strongest proangiogenic effect was induced by sera from patients with HP (mean number of new vessels 16.8), CD (16.6), sarcoidosis (16.3), IPF (16.2), and PNC (15.7). In the case of DLD (13.2), the effect was comparable to healthy controls (13.5). In contrast, sera from SCL (mean number of the vessels 10.5) and HIS patients (10.8) significantly inhibited angiogenesis compared with controls. The angiogenic activity of sera from patients with hilar or mediastinal lymph nodes involvement was higher than that of sera from patients with lung fibrosis. There were also differences in the serum angiogenic activity in relation to the severity of dyspnea. CONCLUSIONS: The data showed that sera from ILD patients constitute a source of mediators modulating angiogenesis, but the pattern of reaction is different in various diseases. Sera from HP, sarcoidosis, IPF, and CD patients demonstrated the strongest proangiogenic activity. However, sera from SCL and HIS inhibit angiogenesis. Angiogenic activity of examined sera was related to the clinical and radiological changes.

Modulatory effect of sera from sarcoidosis patients on mononuclear cell-induced angiogenesis.

Sarcoidosis (SAR) is a systemic granulomatous inflammatory disease characterized by recruitment and activation of peripheral blood mononuclear cells to the sites of disease. Neovascularisation is a principal vascular response in chronic inflammation and hypoxia. The aim of the study was to evaluate the effect of sera from sarcoidosis patients on angiogenic capability of different subsets of normal peripheral human mononuclear cells (MNC) in relation to IL-6 and IL-8 serum levels, to radiological stages of disease and to the presence of extrapulmonary changes. Serum samples obtained from 42 sarcoidosis patients were examined. There were 12 patients in stage I, 16 patients in stage II, and 14 in stage III. In order to quantify angiogenesis, a leukocyte-induced angiogenesis assay was performed by a method of Sidky and Auerbach. MNC were depleted in monocytes by glass adherence and phagocytosis of iron particles techniques. IL-6 and IL-8 in sera from sarcoidosis patients were evaluated by an ELISA-based assay. Sera from sarcoidosis patients enhanced angiogenic capability of normal MNC significantly stronger than sera from healthy donors (P<0.001). Angiogenic activity of sera in sarcoidosis depended on the stage of disease and appeared most pronounced in stage II (P<0.05). Sera from patients with extrapulmonary changes exerted stronger effect on angiogenesis than sera from patients with thoracic changes only (P<0.001). IL-6 and IL-8 serum level correlated with each other, but no correlation was found between IL-6 and IL-8 serum level and angiogenic activity of the examined sera. Removal of monocytes from MNC eliminated the effect of sera from sarcoidosis patients on angiogenesis compared with the effect of these sera on intact MNC (P<0.001). Sera from sarcoidosis patients and from healthy people constitute a source of mediators participating in angiogenesis. Sera from sarcoidosis patients prime monocytes for production of proangiogenic factors.

Humoral immune response against 38-kDa and 16-kDa mycobacterial antigens in bone and joint tuberculosis.

SETTING: The diagnosis of bone and joint tuberculosis (BTB) is difficult, and diagnostic delays often occur. A reliable serological test detecting anti-mycobacterial antibodies would thus be of some use in this form of the disease. OBJECTIVE: To evaluate the diagnostic accuracy of an assay detecting IgG against 38-kDa and 16-kDa recombinant mycobacterial antigens in BTB. MATERIALS AND METHODS: In a prospective study, serum samples from 124 subjects were examined: 30 BTB cases, 40 non-specific bone and joint infection patients (NSBI), 30 lung cancer patients (LC), and 24 healthy volunteers (HC). An ELISA-based test (Pathozyme TB complex plus) was used. RESULTS: The cut-off level was established at 150 U/ml according to receiver operating characteristic (ROC) curves. The quantified level of sensitivity of the test detecting BTB was 56%, at a specificity of 99%. The positive and negative predictive values were respectively 94% and 88%. Mean IgG level in the BTB group was 470 +/- 761 U/ml (mean +/- SD), and was significantly higher than the antibody level in the control groups (NSBI 58 +/- 42 U/ml, LC 43 +/- 38 U/ml, HC 40 +/- 29 U/ml). CONCLUSION: The test presents an acceptable level of sensitivity and very good specificity in the diagnosis of BTB, and can be used in combination with other methods to increase diagnostic accuracy in this disease.

Influence of previous treatment on palliative effect of HDR brachytherapy in advanced esophageal cancer.

General effectiveness and influence of previous treatment on value of palliative HDR brachytherapy were assessed in 35 patients with advanced esophageal cancer treated from 1992 till 1997 with brachytherapy HDR (BT). Twelve of them were treated only with BT, II received previously chemoradiotherapy (CHTT), 12 teleradiotherapy (TT). BT appeared to be effective method of palliation. No significant differences in effectiveness of BT in analyzed groups were observed. Sever complications were observed in 9 cases (26%), and that in patients treated previously. Brachytherapy seems to be efficient after previous treatment, however, in this case, the risk of complications increases.

Efficacy and toxicity of MDR versus HDR brachytherapy for primary vaginal cancer.

The retrospective analysis includes a group of 50 patients with primary, invasive vaginal cancer treated with brachytherapy in the period of 1982-1993. Over 80% cases were squamous cell carcinoma. There were 14 patients in stage I according to FIGO classification and 20%, 36%, and 16% of patients in stage II, III and IV, respectively. Twenty one patients (42%) received MDR brachytherapy using Cs137 source, the remaining 29 (58%) were treated with HDR using Co60 or Ir192 sources. Among 50 patients 31 (62%) received also external beam irradiation. An overall 5-year actuarial disease-free survival was 40%, and it was 78.6% (11/14), 40% (4/10), 27.8% (5/18), 0% (0/8) for stage I, II, III and IV, respectively. For MDR or HDR5-year disease-free survival was 38% and 41%, respectively. No influence of dose rate on survival has been found (p=0.7). Local failure occurred in 20 patients (40%). Recurrences appeared in 10 patients (20%). Late complications rate was 0% and 17% for MDR and HDR, respectively. Effectiveness of brachytherapy MDR and HDR was similar, whereas serious late complications developed more often after HDR brachytherapy.

[Lowering the promille limit?]. / Absenkung der Promille-Grenze?

The Legislator's decision not to lower the 0.8 per mile alcohol level limit of the section 240 StVG runs counter to the tendency of fighting dring driving altogether. This decision was made despite the fact, that according to current medical science the risk limit lies at 0.4 per mile. It can't be justified by the "ultima ratio" principle which was introduced by the legislator for decision making. Much on the contrary, it suggests a development where considerations will no longer be applied only for the protection of the citizen. Here we can observe a continuation of the interpretation of the alcohol level limits which seem to simply serve as a means of ensuring a conviction. The economical analysis of the law is the theoretical background to this consideration which dominated by this process. This analysis does not take any further limitations of legislative powers into consideration with the exception of effectiveness, efficiency and its maximum use under the political and economic aspects. Therefore it allows the protection of the individual to be obscured by these maxims. However, lowering of the alcohol level risk limit to 0.4 per mile should not be insisted on, but instead there should be a call for the introduction of an alcohol ban altogether. This request could be justified with the lack of the legal basis of the alcohol level limits.

[Diagnostic pitfalls in stereotactic biopsy]. / Trudnosci diagnostyczne w ocenie materialu z biopsji stereotaktycznej.

Between October 1998-August 2000, 65 patients were diagnosed, and underwent stereotactic biopsy of brain lesions. Procedures were performed with the Riechert-Mundinger stereotactic device. The diagnosis was made intra-operatively, by examination of cytological smears. The initial diagnosis was confirmed after H&E, and selective stains, as well as immunohistochemical examinations of paraffin specimens. The method applied makes possible to obtain a reliable, and precise morphological diagnosis in the majority of cases, so that a proper treatment method could be introduced.

[Determining the optimal time for synovectomy in rheumatoid arthritis of the knee joint]. / Przyczynek do próby okreslenia momentu synowektomii w przebiegu reumatoidalnego zapalenia stawu kolanowego.

In 108 patients with rheumatoid arthritis in whom before 4 years synovectomy of the knee joint was performed the relationship between the clinical state and selected indices of inflammatory process was studied. The clinical state of patients was evaluated using modified Gschwend test. Using the Mahalanobis D2 test no relationships between the erythrocyte sedimentation rate, Waaler-Rose test results, and seromucoid level during pre-surgery period on one side and the actual clinical state of patients were stated. According to the authors opinion the decision concerning the surgical treatment should be based solely on clinical state of patients and not on indices of inflammatory process.

[Surgical, biological and histological evaluation of radiation-sterilized Dallop-type muscle fascia prostheses]. / Ocena chirurgiczno-biologiczna i histologiczna sterylizowanych radiacyjnie protez powiezi miesni Dallop.

The behaviour of Dallop knitted polyester nets, produced by the Research and Development Centre of Knitting Industry in lódz was experimentally tested. The prostheses were implanted in dog's abdominal walls, in subcutaneous tissue and in muscles fascias. After six months observation it was stated that they may be used in surgical clinic because of the small tissue reaction and proper healing into tissues. New type of packages for radiative sterilization was also favourably evaluated.