Correlations between cyclooxygenase-2 expression and angiogenic factors in primary tumors and liver metastases in colorectal cancer.

BACKGROUND: Angiogenesis is required for growth and metastasis of colorectal cancer (CRC), and several positive regulators of tumor angiogenesis have been identified. Cyclooxygenase-2 (COX-2), known to be elevated in several human cancers, regulates angiogenesis by inducing angiogenic factors. The aim of this study was to clarify the levels and evaluate the relationships of COX-2, vascular endothelial growth factor A and C, thymidine phosphorylase (TP) and microvascular density (MVD) in paired tissue specimens between primary CRC and corresponding metastatic liver cancer. METHODS: Tissue samples from pairs of primary tumors and corresponding metastatic liver tumors from 44 patients with CRC were immunohistochemically evaluated for COX-2, VEGF-A, VEGF-C, TP and MVD. RESULTS: The primary and corresponding metastatic liver tumors tended to show concordant immunoreactivity for COX-2 (P = 0.005, rs = 0.428), VEGF-A (P = 0.039, rs = 0.314), TP (P = 0.005, rs = 0.422) and MVD (P = 0.046, rs = 0.304) by Spearman rank test. The rate of COX-2 immunoreactivity was higher in liver metastases than in primary tumors (P = 0.002), while the rate of VEGF-A was higher in primary tumors than in liver metastases (P = 0.0004). The incidence of TP immunoreactivity and the level of MVD did not differ between primary and metastatic liver tumors (P = 0.247; P = 0.229). Significant correlations were found between COX-2 immunoreactivity and VEGF-A immunoreactivity in metastatic liver tumors (P = 0.033) as well as in primary tumors (P = 0.008). CONCLUSION: The positive correlations between COX-2, VEGF-A, TP and MVD in primary CRC and liver metastasis as demonstrated here will help to predict the angiogenic activity of liver metastasis by analyzing primary tumors, allowing for individualized cancer treatment options.

Colecistectomia videolaparoscópica em paciente submetido a implante cardíaco: relato de caso e revisão de literatura / Laparoscopic cholecystectomy in patient with heart transplant: case report and review of literature

O transplante cardíaco é realizado em escala crescente como tratamento para a doença cardíaca em estágio terminal. Embora a colelitíase seja frequente em ambos os pacientes pré e pós-transpolante, as opiniões divergem em relação a conduta a ser tomada. Pacientes pré-transplante apresentam riscos cardíacos bem reconhecidos e pacientes pós-transplante imunossuprimidos estão sob considerável risco para complicações sépticas. Devido à colecistite aguda ser frequente a primeira apresentação da colelitíase nessa população, os cálculos assintomáticos não devem ser considerados benignos, parecendo razoável recomendar avaliação pré-transplante e acompanhamento após o transplante para a sua detecção. Colecistectomia laparoscópica profilática deve se realizada nos pacientes estáveis a fim de evitar a alta mortalidade associada com colecistite aguda pós-operatória e colecistectomia de urgência. Este trabalho tem por objetivo relatar o caso de um home de 44 anos de idade, transplantado cardíaco, que apresentou colecistite aguda após um um ano e sete meses da cirurgia cardíaca, sendo submetido à colecistectomia videolaparoscópica sem intercorrências