Functioning of people with colorectal cancer during chemotherapy. Demographic and clinical determinants of quality of life of patients with colorectal cancer receiving chemotherapy. Pilot study.

Cancer of the colon is one of the most common malignant tumours in both genders. Thanks to the development of diagnostic techniques, lesions can be detected early fostering full patient's recovery. The aim of this study was to investigate factors affecting quality of life of patients with colorectal cancer (CRC) during chemotherapy. The research tool was a questionnaire of our own design that allows collecting demographic and clinical data and Functional Assessment of Cancer Therapy Scale-Colorectal (FACT-C). The study included 90 patients. The analysis confirmed the difference between Social-Family Well-Being (SWB) and Emotional Well-Being (EWB) and in the overall assessment of quality of life and age. Taking into account the presence of stoma, a statistically significant difference was found only in the Colorectal Cancer Subscale (CCS p = .01321). Regarding the number of cycles of chemotherapy, a statistically significant difference was shown in the overall evaluation (p = .0459) and the SWB (p = .0463) area. In patients with CRC in the general assessment of quality of life, which is at a medium level, non-modifiable factors like age and gender play a minor role when compared with the group of variables related to the process and treatment of the disease.

Human splenic dendritic cells react differently to bacterial and allogeneic antigens.

We investigated the ability of bacterial (cells, LPS, and DNA) or allogeneic antigens to stimulate splenic dendritic cells (DCs) and expression of Toll-like receptors (TLRs), CD14 (co-functional molecule to TLR), CD83 (activation molecule on migrating DCs), CD123 (IL-3R specific for myeloid DC), Hsp60 and Hsp90 (heat shock proteins) involved in recognizing pathogen-associated molecular patterns (PAMP) and other pathogen recognition receptors (PRR) ligands. Allogeneic stimulation of DC TLRs was weak compared with that of bacterial products. This suggests that the highly conserved TLRs destined to react to bacterial products do not recognize donor products differing at the major histocompatibility complex (MHC) locus, at least using in vitro culture conditions.

Activation of splenic dendritic cells by bacterial and allogeneic antigens.

Allograft ischemia and cellular degradation accompanying rejection favor graft colonization by translocated microorganisms. Bacterial colonization adds to the graft destruction. The dendritic cells (DC) of allograft recipients engage in allogeneic and antibacterial reactions; they process and present to lymphocytes 2 types of antigens. This may lead to overstimulation of DCs that may nonspecifically intensify the rejection process. We investigated the effects of allogeneic and bacterial antigens on splenic DCs phenotypes. In vitro stimulation of a spleen DC-enriched population by E. coli, LPS, and CpG DNA brought about an increase in expression of OX6(+) (MHC class II) from 47.4% in the control cells to 65% in the E. coli-stimulated group (P < .05) and 85% in the LPS and CpGDNA groups (P < .05). Interestingly, a significant drop in the frequency of OX62(+) DC was observed after incubation with LPS. Allogeneic heart transplants brought about an increase of OX6(+) in DCs to 100% and a decrease of ED1(+) monocyte frequency. Simultaneously, an increase in expression of W3/13(+) T cells in DC-enriched splenic cells was observed. There was no significant change in the frequency of OX62(+) expression. Both types of antigens evoked splenic DC response; however, there were differences in the frequency of phenotype expression. Allogeneic but not bacterial antigens increased W3/13 antigen expression; the frequency of OX62(+) in cells decreased after LPS but not after bacterial stimulation.

DNA released from rejecting organs is an indicator of the degree of graft cellular damage.

Warm and cold ischemia as well as rejection of the transplanted organ or tissue cause destructive changes in the graft parenchyma. Fragments of disintegrated cellular organelles are phagocytized and digested by recipient scavenger cells in lymph nodes, spleen, and liver. Some fragments engulfed by dendritic cells are processed including donor DNA present in the ingested cellular debris. The question arises as to whether the DNA from the disintegrated cells may be used as a measure of graft damage. In this study we provide evidence that both syngeneic and allogeneic organ transplantation followed by "seeding" of donor DNA from graft cells is internalized in recipient macrophages and dendritic cells in lymphoid organs. The kinetics of accumulation of donor DNA in recipient tissues reflected the degree of ischemic and immune graft damage. Immunosuppression with cyclosporine or tacrolimus did not significantly attenuate the DNA release. Measurements of the concentration of donor DNA gives insight into the kinetics of allograft rejection. Real-time polymerase chain reaction for donor DNA in recipient serum and blood leukocytes that have engulfed donor cell debris may be useful for clinical diagnostic application.

Transplantation of organs is transplantations of donor DNA: fate of DNA disseminated in recipient.

Microchimerism after allogeneic organ transplantation has been widely documented using DNA identification techniques. However, the question as to whether the detected donor DNA is present in the surviving donor passenger cells, recipient macrophages phagocytizing rejected donor cells, or dendritic cells (DC) internalizing donor apoptotic bodies or cell fragments has not been answered. We provide evidence that allogeneic organ transplantation is followed not only by cellular microchimerism caused by release of graft passenger cells but also dissemination of donor DNA from the ischemic rejecting graft cells and its internalization in recipient DC. The high levels of donor DNA at the time of heart rejection were inversely proportional to the concentration of donor passenger cells detected with use of flow cytometry. Depending on the type of graft, the kinetics of DNA distribution in recipient tissues were different. Immunosuppressive drugs attenuated the rejection reaction and release of DNA from grafts. Allogeneic but not syngeneic donor DNA fragments were found in recipient splenic DC-enriched population. Interestingly, that donor DNA fragments could be detected in recipient tissue at high levels on day 30. This challenges the notion that fragments of DNA are immediately cleaved by cell plasmatic enzymes. The biologic significance of our findings is not clear. We speculate that donor DNA fragments in recipient DC may play a, so far unknown, role in the immunization/tolerance process to allogeneic antigens.

Similar response of dendritic cells to bacterial and allogeneic antigens.

The dendritic cells (DC) of an allograft recipients become engaged not only in an allogeneic but also antibacterial reaction. They react to the alloantigens and microorganisms which colonize the rejecting grafts. This leads to overstimulation of DCs what may non-specifically intensity the rejection process. We investigated the effects of allogeneic and bacterial antigens on splenic DCs phenotypes. In vitro stimulation of spleen DC-enriched population by E. coli, LPS and CpG DNA brought about an increase in expression of OX6 (MHC class II) from 47.4% in the control population to 65% in the E. coli stimulated group (p < 0.05) and to 85% in the LPS and CpGDNA groups (p < 0.05). Interestingly, a significant drop in the frequency of OX62+ antigen was observed after incubation with LPS. Allogeneic heart transplants brought about an increase of OX6+ (MHC class II) DCs to 100% and a decrease of EDI+ cells. Simultaneously, an increase in expression of W3/13 on DC-enriched splenic cells was observed. There was no significant change in the frequency of OX62+ expression in conclusion, both bacterial and alloantigens strongly activate splenic DCs what may add to the intensity of the rejection process.

DNA from rejecting donor organs can be detected in recipient lymphoid and non-lymphoid tissues.

Rejecting tissue and organ grafts shed cellular debris from damaged cells. Cellular debris contains fragments of nuclei with their genetic material. The question arises what is the fate of donor DNA in recipient fluids and tissues. Is it enzymatically disintegrated and becomes a waste product or it is utilized by recipient cells. We have shown, using sex-mismatched transplants and the Sry-gene fragment PCR detection method, that at the time of rejection recipient tissue contain donor DNA. The concentration of donor DNA did not parallel the concentration of live donor passenger cells. There were differences in donor DNA concentration depending on whether heart, skin or BMC were transplanted. Moreover, there was more donor DNA in recipient tissues than in control syngeneic transplants. Interestingly, a relatively high donor DNA concentration was detected in syngeneic recipients reflecting the extent of non-immune pre-transplantation ischemic damage of the graft.

Interaction of E. coli with dendritic cells--a model for studies of graft infections.

The rejection process of skin allografts is mediated by dendritic cells (DC) and lymphocytes. The recipient DCs are engaged not only into an allogenic but also antibacterial reaction to the penetrating bacteria. The capacity of these cells to sample sites of pathogen entry, respond to microbial signals and activate naive T cells suggests a critical role for DC in initiating antimicrobial immunity. In our study, we investigated the ability of the green fluorescent protein (Gfp) labelled E. coli to infect DC. We studied kinetics of in vitro and in vivo adherence and incorporation of E. coli by rat spleen and bone marrow (BM) DC. Bacterial adherence to the cell surface was observed after 2 h incubation of DC with bacteria. A 24-hour culture of DC from both sources was followed by bacterial adherence to all cells and engulfment by at least 50% of cells. There was an increased expression of the phenotypic markers on the DC cultured with E.coli. The Gfp-labelled E.coli should be useful for studies of the activation of dendritic cells. The method will allow to study the process of simultaneous activation of DC by allo- and bacterial antigens.

Factors related to the early and late success of direct current cardioversion of chronic nonrheumatic atrial fibrillation: An echocardiographic study.

OBJECTIVES: To assess factors related to the success of restoration and one-year maintenance of sinus rhythm in chronic (more than 48 h) nonrheumatic atrial fibrillation (AF). METHODS AND RESULTS: One hundred and fifty consecutive patients aged 62+/-9 years with AF lasting 123+/-254 days were evaluated clinically with transthoracic and transesophageal echocardiography before elective direct current cardioversion. Heart chamber dimensions and left ventricular ejection fraction were measured. The presence of left atrial thrombi and spontaneous echocardiographic contrast as well as flow velocities in the left atrial appendage were assessed. The first cardioversion was followed by standardized two-step antiarrhythmic treatment including a second cardioversion, if necessary. Twenty patients (13%) spontaneously reverted to sinus rhythm (S) during anticoagulation preceding cardioversion, 81 (54%) were successfully cardioverted (Y), and in 49 (33%) cardioversion failed initially (N). No differences were noted between the two latter groups. However, S patients had smaller left atria measured in the short and long axes (42+/-4 mm, P=0.05, and 53+/-7 mm, P=0.005, respectively) than both the Y (45+/-4 and 61+/-8 mm) and the N patients (46+/-4 and 61+/-8 mm). One-year follow-up was obtained in 95 patients: 64 (67%) were in sinus rhythm while 31 (33%) had AF. Again, no initial differences predicting the maintenance of sinus rhythm were found. CONCLUSIONS: Spontaneous reversion of AF seems more likely with smaller left atria. Echocardiography, including trans-esophageal echocardiography, is unlikely to identify patients in whom attempts to restore and maintain sinus rhythm will fail or succeed.

Detection of patients at risk for recurrence of atrial fibrillation after successful electrical cardioversion by signal-averaged P-wave ECG.

The aim of the study was to assess the value of signal-averaged ECG of P-wave in predicting recurrence of atrial fibrillation after direct-current electrical cardioversion of chronic atrial fibrillation. The signal-averaged ECG triggered by P-wave was recorded in 35 patients after successful electroconversion. Duration of the high frequency P-wave and the root mean square voltages for the last 20 ms (RMS20) P-wave of the vector magnitude were calculated. After 6 months follow-up recurrence of atrial fibrillation was observed in 11 patients (group I) and in 24 patients sinus rhythm was maintained (group II). A filtered P-wave was significantly longer in group I with recurrence of atrial fibrillation, than in patients from group II who maintained sinus rhythm (145+/-11.8 vs 130+/-10.8 ms, p<0.001). RMS20 was significantly lower in group I than in patients from group II (1.6+/-0.6 vs 2.2+/-0.9 microV, p<0.02). A filtered P-wave of duration >q37 ms associated with a RMS 20 ms <1.9 microV had a sensitivity of 73% and specificity of 71% for the detection of patients with recurrence of atrial fibrillation after successful direct-current electrical cardioversion of chronic atrial fibrillation. These results suggest that signal-averaged ECG of P-wave may be helpful for identification of patients with recurrence of atrial fibrillation after successful direct-current electrical cardioversion.

Amiodarone in restoration and maintenance of sinus rhythm in patients with chronic atrial fibrillation after unsuccessful direct-current cardioversion.

BACKGROUND: When direct-current (DC) cardioversion is used, sinus rhythm can be restored, at least temporarily, in 80-90% of patients with atrial fibrillation. However, there is a small but significant group of patients with chronic atrial fibrillation in whom DC cardioversion has failed to restore sinus rhythm. The value of antiarrhythmic drug pretreatment before DC cardioversion is still controversial. HYPOTHESIS: The aim of our study was to assess (1) the effectiveness of repeat DC cardioversion in patients with chronic atrial fibrillation after pretreatment with amiodarone, and (2) the efficacy of amiodarone in maintaining sinus rhythm after repeat cardioversion. METHODS: Forty-nine patients with chronic atrial fibrillation after ineffective DC cardioversion were included in the study. Repeat DC cardioversion was performed after loading with oral amiodarone, 10-15 mg/kg body weight/day for a period necessary to achieve the cumulative dose of over 6.0 g. RESULTS: Spontaneous conversion to sinus rhythm during amiodarone pretreatment was achieved in 9 of 49 patients (18%). Direct-current cardioversion was performed in 39 patients and sinus rhythm was achieved in 23 of these patients (59%). Mean heart rate decreased from 95 beats/min before to 68 beats/min after DC cardioversion (p < 0.001). Systolic blood pressure significantly (p < 0.05) decreased from 126 +/- 23 to 108 +/- 25 mmHg. Complications occurring in four patients just after electroconversion were well tolerated and of short duration. After 12 months, 52% of patients maintained sinus rhythm on low dose (200 mg/day) amiodarone therapy. CONCLUSION: Pretreatment with amiodarone and repeat DC cardioversion allows for restoration of sinus rhythm in about 65% of patients with chronic atrial fibrillation after first ineffective DC cardioversion. Direct-current cardioversion can be performed safely with the use of standard precautions in patients who are receiving amiodarone. At 12 months' follow-up, more than 50% of patients maintain sinus rhythm on low-dose amiodarone after successful repeat cardioversion.

[P-wave ekg averaging technique--a new method of selecting patients with paroxysmal atrial fibrillation]. / Technika usredniania zalamka P ekg--nowa metoda wyodrebniania chorych z napadowym migotaniem przedsionków.

The aim of study was to assess the value of signal averaged ecg for detection of patients (pts) at risk for paroxysmal atrial fibrillation (paf). We examined three groups of pts: group I-41 pts with nonvalvular paf, group II-20 pts with hypertension and/or ischemic heart disease without paf and group 3-26 health persons, without organic heart disease. In all pts the signal-averaged electrocardiogram triggered by P waves was recorded. Seven parameters of the spatial magnitude of filtered P wave were measured. Significant difference between group I and group II or III was found in most parameters. Using the method of multidimensional variance analysis we constructed "the diagnostic vector" in multidimensional parameters space, which was used to determine patients belonging to group. Total percent of right decision was 85%. These findings suggest that pts at risk for paf could be detected while in sinus rhythm by using the P wave-triggered signal-averaged ecg.

[Lactate metabolism in acute myocardial infarction]. / Metabolizm mleczanu w ostrym zawale serca.

In 18 patients with acute myocardial infarction admitted to the Cardiological Care Department within 6 hours after the onset of chest pain, before administration of drugs and then in the 2nd, 3rd, 5th and 7th day, the levels of glucose, pyruvate, lactate in venous blood, the lactate/pyruvate ratio (L/P) and pH, actual hydrocarbons, PCO2 and PO2 in capillary arterialized were determined. Depending on the clinical status at admission the patients were classified into 2 groups: I--without complications (I class according to Killip-Kimbal; n = 10), and II--with complications (II-IV class of cardiac failure according to Killip-Kimbal and/or complex ventricular arrhythmias e.i. III-V class according to Lown and heart block of Mobitz--type II and III degree; n = 8). None of the patients had diabetes, chronic respiratory tract diseases, renal failure and liver cirrhosis. The control group consisted of 11 healthy persons. On the first day of myocardial infarction, the significant increase of blood glucose, lactate, pyruvate, as well as significant decrease of blood pH, HCO3- and PO2, and non significant increase of L/P ratio were observed in both groups as compared to the control group. Also there were non significant difference of the glucose, lactate, pyruvate L/P ratio and pH, PCO2 and HCO3- values between the I and II group on the first day of the acute myocardial infarction, with exception of the PO2, which was significantly lower in the group II. In the following days an increase of PO2 was observed. Since this effect coincided with a decrease of lactate concentration (significant only in the group II) it could be concluded, that the observed decrease of the lactate concentration resulted from the higher supply of oxygen. The obtained results have shown, that increase of glycaemia values and decrease of PO2 values may be considered as biochemical markers for hemodynamic complications of acute myocardial infarction.

Anomalous inferior vena cava mimicking aortic dissection on transesophageal echocardiography.

Transesophageal echocardiography (TEE) is considered an excellent method for the diagnosis of aortic dissection, especially that involving the descending aorta. It has also proved useful in the evaluation of conditions mimicking aortic dissection, usually disclosing in these situations other types of severe aortic disease. We are not aware of any report dealing with venous abnormalities which presented diagnostic problems in a patient evaluated with TEE because of a suspected aortic dissection.

[Influence of diabetes on the clinical course and hospital mortality of patients with recent myocardial infarction]. / Wplyw cukrzycy na przebieg kliniczny i smiertelnosc wewnatrzszpitalna chorych ze swiezym zawalem serca.

In group of 1026 patients with recent myocardial infarction (from program "Streptokinase in acute myocardial infarction"--patients below 70 years old, up to 12 hours from the onset of the symptoms) we analyzed the influence of diabetes on clinical course and hospital mortality. In this group were 77 patients with noninsulin-dependent diabetes (NIDDM), and 21 patients were insulin-dependent diabetes (IDDM). The risk factors of coronary heart disease and myocardial infarction in the past were significantly more often in patients with diabetes than in subjects without diabetes. In hospital mortality was significantly higher (p < 0.05) in group of patients with diabetes (17.3%) than in group without diabetes (9.5%). Reinfarction in the hospital period occurred significantly more often in diabetes group (p < 0.01). Congestive heart failure was observed in 50% patients with diabetes and in 32.3% cases without diabetes (p < 0.01), the left ventricle aneurysm occurred accordingly 9.8% i 5.2% (N.S.). Early ventricular fibrillation and atrio-ventricular blocks occurred with the same frequency in the both groups. We analyzed also the influence of thrombolytic therapy on clinical course in patients with diabetes proving the benefit of this treatment.

[Prognostic value of an early peak CK-MB in plasma of patients treated with streptokinase for acute myocardial infarction]. / Wartosc prognostyczna wczesnego szczytu aktywnosci CK-MB w surowicy u chorych leczonych streptokinaza w ostrym zawale serca.

111 patients below 70 years old, with the first acute myocardial infarctions, 6 hours since the pain occurred--have been treated with streptokinase i.v. In 102 patients we obtained full curve of CK-MB activity. Early peak of CK-MB activity < 15 hours after onset of symptoms we have observed in 59 patients, and late peak of CK-MB activity > 15 hours in 43 patients. There was not any significant statistics differences between early and late groups in frequency of: early ventricular fibrillation (< 48 hours), complex ventricular arrhythmia (in 21 day), heart failure and in-hospital mortality. 1 patient died in hospital in early group and in late group also died 1 patient. The follow-up period was from 10 to 48 months (av. 26 +/- 13). 100 patients left the hospital and the full informations we have obtained in 97 cases. No one died in that time. In the group with early peak CK-MB activity we observed more often the unstable angina and the new myocardial infarction (21%) than in the group with late peak of CK-MB activity (15%), but these differences were nonsignificant. In conclusion our results don't confirm that the early peak of CK-MB activity is the positive risk factor of unstable angina and the new myocardial infarction.

[A method of averaged ECG signal does not identify patients with ventricular tachycardia in disorders of intraventricular conduction]. / Technika usredniania sygnalu EKG nie pozwala na wyodrebnienie chorych z czestoskurczem komorowym przy zaburzeniach przewodnictwa sródkomorowego.

Conduction defect are known to delay and fragment the ecg signal and may be expected to cause changes on the signal-averaged ecg that mimic ventricular late potentials. The aim of our study was to asses whether signal-averaged ECG (SAE) identify patients (pts) with sustained ventricular tachycardia (VT) after myocardial infarction (MI) who display right or left bundle branch block (RBBB or LBBB). We studied 23 pts with RBBB and 25 pts with LBBB. SEA was recorded with bidirectional filters at 25-250 HZ and 40-250 Hz using Simson method. The total filtered QRS duration (QRSd), root mean square voltage in the terminal 40ms of the QRS (RMS40) and low amplitude signal duration less than 40uV (LAS40)) were measured. Signal-averaged parameters with a filter at 25-250 Hz were: [table: see text] Signal-averaged parameters with a filter at 40-259 Hz were: [table: see text] In conclusion SAE parameters do not allow separation of pts with sustained VT from pts with RBBB or LBBB after MI. These data indicate that conduction defects have effects on signal-averaged ecg parameters and may result in masking of ventricular late potentials.

[Diagnosis of congenital anomaly of the inferior vena cava simulating aortic dissecting aneurysm by the method of transesophageal echo- cardiography]. / Wrodzona anomalia zyly glównej dolnej nasladujaca rozwarstwienie aorty w badaniu metoda echokardiografii przezprzelykowej.

A case of 59 year old woman with acute myocardial infarction is presented in whom chest X-ray film revealed double outlined aortic arch suggestive of dissection. Transesophageal echocardiography (TEE) disclosed presence of two vascular canals in the place of thoracic aorta. Atypical dissection of thoracic aorta or a vascular anomaly were suspected because the image of dissection of intima was not characteristic and no connection between the two canals was found. Computed tomography ruled out presence of aortic aneurysm but the image of inferior vena cava was difficult for interpretation. Final diagnosis of congenital anomaly of inferior vena cava, originating from two iliac veins, passing along left side of the spine and emptying to the right atrium at the level of aortic arch, was established by means of cavography. Familiarity with TEE image of this vascular anomaly may allow avoidance of diagnostic error in cases suspected of aortic dissection.

[Atrial natriuretic peptide level in acute myocardial infarction]. / Stezenie przedsionkowego peptydu natriuretycznego w swiezym zawale serca.

Concentration of atrial natriuretic peptide (ANP) was studied in acute myocardial infarction (AMI), its association with ventricular arrhythmias (VA), left ventricular dysfunction and infarct size. Plasma ANP concentrations were measured at time: 0, 4, 8, 16, 24, 48 and 72 hours after admission in 11 patients (pts) with first AMI, up to 6 hours after the first symptoms. Ventricular arrhythmia was assessed by 24 hour Holter monitoring, left ventricular dysfunction by echocardiography and infarct size by serial CK-MB measurement in first 72 hours of AMI. In subsequent measurements the average plasma concentration of ANP (mean +/- SEM) was elevated: 42.2 +/- 9.9, 35.3 +/- 12.5, 33.9 +/- 8.3, 42.3 +/- 8.3, 36.9 +/- 6.4, 60.7 +/- 9.3, 47.8 +/- 12.0 fmol/ml. The maximal plasma ANP concentration was significantly higher (p less than 0.01) in 4 pts with VA 4th grade acc. to Lown than in 7 pts without VA (102.6 +/- 17.9 vs 41.1 +/- 6.4). The maximal level of ANP--153.3 fmol/ml in a patient with paroxysmal supraventricular tachycardia was observed. There were no significant correlations between plasma ANP and infarct size, size of left atrium and contractility disturbances of left ventricle.