Changes in γδT Cells in Peripheral Blood of Patients with Ulcerative Colitis Exacerbations.

The role of γδT cells in ulcerative colitis (UC) is well confirmed in experimental animals and demonstrated in many clinical observations. Recent investigations have indicated that UC is associated with several forms of immune imbalance, such as an imbalance between effector T cells and regulatory T cells. However, little is known about the cellular aspect of clinical colitis exacerbations. We observed 140 patients with histologically confirmed UC over the course of 8 years. We investigated the percentage of γδT and αßT cells in peripheral blood of patients and also the expression of various surface markers (CD25, CD54, CD62L). Patients were assembled into stable colitis and exacerbated colitis groups. The percentage of γδT and αßT cells was evaluated by Ortho Cytorone Absolute flow cytometer. In patients with exacerbated colitis we observed a decrease of γδT cells in peripheral blood and an increased ratio of αßT/γδT. Additionally, we found that exacerbation results in a significant increase of percentage of γδTCD25, γδTCD54 and γδTCD62L lymphocytes in peripheral blood when compared to patients with stable colitis. Exacerbation of ulcerative colitis results in a decreased percentage of γδT cells in peripheral blood with increase of CD25, CD54 and CD62L expressing γδT cells. This may represent the effect of cell activation and migration, similar to that observed after the surgical trauma. We hope that this observation may help to predict exacerbations in colitis patients.

Pre-operative ultrasound diagnosis and successful surgery of a stomach incarcerated in epigastric hernia: a rare case report.

An incarcerated epigastric hernia (localized in linea alba) is a very rare observation. Here, we present a case of a 66-year-old white male who was admitted to the emergency department due to vomiting and epigastric pain. On physical examination, the only observed abnormality was a painless soft epigastric tumor located in the upper midline, measuring about 12 cm in diameter. The patient claimed that he had the tumor for more than 30 years and it never changed in diameter nor caused him any discomfort. A lipoma was initially suspected. However, an ultrasound of the abdomen revealed an incarcerated stomach, trapped due to the defect in the epigastric abdominal wall. The patient was sent for surgery and the presence of an incarcerated epigastric hernia of the linea alba, which contained the anterior wall of the stomach was confirmed. The presented case confirms that the use of ultrasonography may be an effective method to recognize unusual types of hernias, and that ultrasonography should be routinely used in emergency departments.

Post-operative complications in patients with a significant post-operative decrease in γδT cells.

BACKGROUND: It has previously been shown that appropriate distribution of immune cells between different tissues and organs of the body is required for proper function of the immune system. Our previous work demonstrated that surgical trauma in mice induces γδT lymphocyte migration from peripheral blood to the peritoneal lymphoid organs. These described γδT cells have immunoregulatory activity as they suppress the cell-mediated immune response in vitro. We found a similar phenomenon in patients after different surgical operations. In the current study, we analyse post-operative complications in patients with a significant post-operative decrease in γδT cells. METHODS: We investigated the percentage of γδT cells in peripheral blood of patients undergoing standard surgical procedures (gastric resection, colorectal resection, cholecystectomy and strumectomy) before and 3 days after the operation. The percentage of γδT cells was evaluated by the fluorescence-activated cell sorting cytofluorimeter. Patients were grouped based on the decrease of γδT cells. We compared the number of septic complications in patients with a large and small decrease in γδT cells. RESULTS: After major surgery in the peritoneal cavity (gastric and colorectal surgery), in the group that had a large decrease in γδT cells we found significantly more septic complications than in the group of patients with small γδT decrease. That effect was not visible after less traumatic surgery. CONCLUSION: Surgery results in a decreased percentage of γδT lymphocytes in the peripheral human blood which correlates with the number of septic complications. This observation may help to predict post-operative recovery after gastroabdominal surgery.

The Effect of Surgical Stress on Postoperative Tαß and Tγδ Cell Distribution.

BACKGROUND: It was previously shown that appropriate distribution of immune cells between different tissues and organs of the body is required for proper function of the immune system. Our previous experiments demonstrated that surgical trauma in mice induces Tγδ lymphocyte migration from peripheral blood to peritoneal lymphoid organs. Tγδ cells have regulatory activity as they suppress the cell-mediated immune response in vitro via TGF-ß. In the current study, we aim to evaluate the influence of surgery on both Taß and Tγδ lymphocyte distribution in patients that underwent operation. MATERIALS AND METHODS: We investigated the percentage of Tαß and Tγδ cells in peripheral blood of patients undergoing standard surgical procedures (gastric resection, colorectal resection, cholecystectomy, and strumectomy) before and 3 days after operation. The percentage of Tαß and Tγδ cells was evaluated by FACS Canto II cytofluorimeter. RESULTS: We showed that only major surgery located in the peritoneal cavity (gastric and colorectal surgery) decreases the percentage of Tγδ cells in peripheral blood as opposed to less traumatic surgery (strumectomy and cholecystectomy) which does not have such effect. However, significant reduction of Tγδ cells after operation was only observed in a group of patients that underwent gastrectomy. Additionally, we found that gastrectomy results in significant reduction of cumulative Tγδ CD4 and Tγδ CD25 lymphocyte counts. CONCLUSION: Surgery results in decreased percentage of Tγδ lymphocytes in peripheral human blood, and this correlates with the severity and location of the surgical trauma. This observation may help to predict postoperative recovery after gastroabdominal surgery.

Sensitivity and Specificity of Fractal Analysis to Distinguish Between Healthy and Pathologic Rectal Mucosa Microvasculature Seen During Colonoscopy.

PURPOSE: Conventional endoscopy is limited by human capability to recognize and to differentiate pathology. Fractal analysis of blood vessels has been used in other organs, such as the retina, but never before to supplement colonoscopy. The aim of this study was to assess whether it is possible to differentiate between healthy and pathologic rectal mucosa using fractal analysis of the mucosal microvascular architecture seen during colonoscopic examination (Supplemental Digital Content 1, http://links.lww.com/SLE/A145). METHODS: A total of 300 consecutive patients, 133 females and 167 males with a mean age of 49.1 (±11.3) years, undergoing endoscopy were included in the prospective cohort study. Colonoscopy of the sigmorectal region was performed, and then analyzed with computer-assisted image fractal analysis. RESULTS: Fractal analysis of mucosal vasculature allowed for differentiation between healthy and pathologic rectal mucosa, as well as different pathologies (P<0.0001). The sensitivity of fractal analysis to diagnose rectal neoplasia was 92.8% to 96.4%, while the specificity was 91.9% to 98.5% depending on the fractal parameter. The sensitivity of fractal analysis to diagnose rectal colitis was 84.2% to 92.1%, while the specificity was 95.0% to 96.0%, depending on the fractal parameter. CONCLUSIONS: Computer-assisted fractal analysis allows for differentiation between healthy and pathologic rectal mucosa, as well as between different mucosal pathologies, seen during colonoscopy. Fractal analysis improves the sensitivity and specificity of colonoscopy to aid in the diagnosis of neoplasia or colitis, and should be included in the screening and surveillance of these pathologies.

Gastroscopy in patients with hiatal hernia with and without gastroesophageal mucosal prolapse.

There are still many doubts in the literature regarding gastroesophageal mucosal prolapse (GEMP) and its clinical course. We still do not know what determines mucosal wedging in esophagogastric junction, and what is the role of the anatomy of that site. To investigate that problem we performed 120 upper digestive tract endoscopies in which a hiatal hernia was diagnosed. Patients referred to our unit with different complaints most frequently of typical or atypical gastroesophageal (GE) reflux symptoms. The aim of that study was to assess hernia dimensions in patients with and without GEMP diagnosed during endoscopy. Additionally we analyzed the type and prevalence of gastrointestinal symptoms reported by patients to confirm the observation that GEMP symptoms differ from gastroesophageal reflux disease (GERD) symptoms. METHODS: One-hundred and twenty patients were included in this study. All of the patients were diagnosed with a hiatal hernia during routine gastroscopy. Using standardized methodology the region of the hiatal hernia was photographed, and hernia longitudinal and transverse dimensions were measured. RESULTS: The study group comprised 57 females (52.5%) and 63 males - mean age (SD) 58.5 ± 18.4. Most of the patients had standard GERD symptoms (n = 96; 80%). The average length of hiatus, in patients with GEMP (n = 24; 20%) was 3.56 ± 0.59 cm, and the average width was 2.32 ± 0.62 cm (n = 96; 80%) vs. 4.64 ± 0.74 cm and 2.98 ± 0.68 cm respectively in patients without GEMP (p <0.001). CONCLUSIONS: GEMP occurs in smaller sized hiatal hernias. We confirmed that disease symptoms of the majority of patients with GEMP differ from patient with GERD but without GEMP. However this difference was not significant enough to allow to differentiate between diagnoses based solely on the symptoms.

Hiatal hernia with upside-down stomach. Management of acute incarceration: case presentation and review of literature.

Upside-down stomach (UDS) represents the rarest type of hiatal hernia (<5%) and is characterized by herniation of the entire stomach or most gastric portions into the posterior mediastinum. We present here a very rare complication of such a condition which is incarceration of upside-down stomach. A 54 year-old female was admitted to the emergency department presenting signs of acute epigastric pain radiating into thorax. Computed tomography revealed a giant hiatal hernia with incarceration of the gastric trunk. Immediate operation for reduction of the incarcerated stomach and repair of the hiatal defect was performed. The patient was discharged without any complication and was followed up at the surgical outpatient department. The presented case confirms that differentiation of an acute epigastric or intrathoracic pain in adults should always exclude presence of hiatal hernia which in case of incarceration should be treated by prompt surgical management.

Unsolved questions regarding the role of esophageal hiatus anatomy in the development of esophageal hiatal hernias.

The association of esophageal hiatal hernias with gastro-esophageal reflux disease was recognized long ago, however its origins are still disputed. The anatomy of the diaphragm and esophagogastric junction appears to be crucial to hiatal hernia development. The aim of this paper was to perform a literature review to present the current state of knowledge regarding the anatomy and pathology of esophageal sliding hiatal hernias. An electronic journal search was undertaken to identify all relevant studies published in English regarding esophageal hiatal hernias. This search included the Medline and Embase databases from 1962 to 2013. The following keywords were used in various combinations: hiatus hernia, hiatal, gastro-esophageal reflux disease, etiology, anatomy, and esophageal. The nature of a hiatal hernia is complicated by the multifactorial etiology of the disease, which involves the interplay of genetic and environmental factors. Its anatomy is still a matter of dispute. The exact point at which hernia development begins has yet to be understood.

Nerve supply of pelvic viscera - anatomical notes, clinical implication on nerve stimulation.

AIM: The aim of this study was to present review on pelvic plexuses in males and females with some referrals to clinical practice, specially to the methods including nerve stimulation. CONCLUSIONS: Anatomy of pelvic plexuses is still confusing. Much attention should be paid to further studies on the arrangement of pelvic plexuses specially because of nerve stimulation techniques.

[Sentinel lymph node biopsy as a new approach to colorectal cancer treatment]. / Biopsja wezla wartowniczego--nowy aspekt w chirurgicznym ieczeniu raka jelita grubego.

Some concepts considering sentinel lymph node excision in colon and rectal carcinoma are presented in the paper. Arguments pro and contra were exposed and interpret separately. The problem is still open. Current knowledge indicates that lymphatic system in colon and rectum can be very different in many patients. There is no evidence that sentinel node biopsy in this group can be useful. In patients with advanced colorectal carcinoma (T3, T4 according to TNM classification) sentinel node biopsy cannot replace regional lymph node dissection. Sentinel lymph node biopsy and localization of metastases allows to change the qualification of the NO patients to N1 (upstaging). This means the change of cancer staging in these patients and qualification to chemotherapy. In conclusion we underline that there is still too little knowledge to implement these procedures in clinical practice, that problem needs more consideration.

TCRalphabeta + CD8+ and TCRgammadelta+ lymphocytes inhibit the capability of peritoneal macrophages to induce contact hypersensitivity.

Macrophages (Mf) play an important role in induction and regulation of the immune response. It was shown previously that subcutaneous injection of hapten conjugated macrophages (TNP-Mf) induces the contact hypersensitivity (CHS) response, whereas intravenous (i.v.) or intraperitioneal administration of TNP-Mf results in unresponsiveness as a result of induced T suppressor (Ts) cells. The aim of this study was to determine if different T cell populations influence macrophages to become inducers of immunological suppression. Our findings show that indeed i.v. injection of TNP labeled macrophages isolated from control mice into syngenic recipients induces unresponsiveness. However, i.v. administration of TNP substituted macrophages isolated from TCRalpha-/-, TCRdelta-/- and beta2m-/- mice induces strong CHS similar to that observed after skin painting with TNP-C1. Moreover, it was shown that TNP conjugated macrophages isolated from CD1d-/- mice were still able to promote immunosuppression when injected intravenously. This suggests that TCRalphabeta+ CD8+ and TCRgammadelta+ lymphocytes stimulate macrophages to induce immunosuppression instead of a strong CHS reaction, whereas CD1d dependent NKT cells are not involved in negative regulation of macrophage function.

Mesenteric lymph node Tgammadelta cells induced by gastrectomy in mice suppress cell-mediated immune response in vitro via released TGF-beta.

We have shown previously that gastrectomy, but not laparotomy alone, severely impairs contact sensitivity responses in vivo and selectively alters cell trafficking in gut associated lymphatic tissue. Here, we investigate the immunological role of different subpopulations of mesenteric lymph node cells (MLNCs) in the inhibition of contact sensitivity as well as their suppressive mechanisms. Suppressive cells were isolated from the mesenteric lymph nodes of gastrectomized mice and were added to cultures of lymphocytes from mice immunized with trinitrophenyl-chloride. These MLNCs inhibited the proliferation of sensitized lymphocytes in response to antigen. Depletion experiments revealed that the suppressive MLNCs are Tgammadelta+ cells, but not Talphabeta+ cells. Neutralizing antibodies to IL-4, IL-10, and tissue growth factor-beta (TGF-beta) revealed that suppression was dependent on TGF-beta, but not the other cytokines. We conclude that surgical stress induced by gastrectomy causes accumulation of Tgammadelta+ lymphocytes in gut associated lymphatic tissue and that these cells suppress the cell-mediated response in vitro in an antigen-non specific manner via TGF-beta. This cytokine can possibly prevent in vivo the development of autoimmune responses following severe tissue trauma in the gastrointestinal tract.

[Procedures in treatment of hemorrhoids]. / Leczenie zabiegowe krwawnic.

Current conceptsof ethiopathogenesis and classification of hemorrhoids are presented based on the literature and own experience of the authors. Different surgical and non-surgical methods are discussed with additional description of postoperative treatment and complications.

[Immunological aspects of trauma]. / Immunologiczne aspekty urazu.

Injury breaks anatomical barriers of the body and leads to cell and tissue destruction. In response to trauma, repair and defense mechanisms, involved in tissue repair, wound healing, and prevention of infection, are induced. The magnitude of the trauma-induced response depends on the patient's overall condition and the severity of the injury. Minor injury usually elicits a local reaction, while severe trauma is associated with a systemic host response. In any case, the character of the response is very complex and involves the activation of crucial systems: (immunological, neural, and endocrine. The influence of different types of injury on immune response has been of interest to scientists for many years. Several studies have shown disturbances in innate and adaptive immune response as a consequence of burns, accident trauma, and surgical operation. It is generally accepted that major surgery often leads to severe immunosuppression, usually lasting for several days after injury and characterized by impaired cell-mediated immune response. Both clinical and experimental studies have demonstrated that one of the main causes of surgery-induced suppression of cellular immunity might be a shift in the T helper 1 TH1/TH2 pattern and type-1/type-2 cytokine secretion towards a TH2 response. The type and extent of the body's immune response to injury depends not only on functional changes of immune cells. An appropriate distribution of immune cells among different tissues and organs of the body is also required for proper function of the immune system.

[The influence of trauma on immunological response (the role of Tgammadelta+ lymphocytes)]. / Wplyw zabiegu operacyjnego na odpornosc (rola limfocytów T gamma delta).

The influence of trauma, especially surgical operation on immunological response has not been clarified sufficiently. The authors discuss the influence of surgical trauma on humoral and cell mediated immune response and on phagocytosis as well. The role of Tgammadelta+ lymphocytes in immunological processes that occur after trauma have been also discussed.