RESUMEN
The clinical performances of six molecular diagnostic tests and a rapid antigen test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were clinically evaluated for the diagnosis of coronavirus disease 2019 (COVID-19) in self-collected saliva. Saliva samples from 103 patients with laboratory-confirmed COVID-19 (15 asymptomatic and 88 symptomatic) were collected on the day of hospital admission. SARS-CoV-2 RNA in saliva was detected using a quantitative reverse transcription-PCR (RT-qPCR) laboratory-developed test (LDT), a cobas SARS-CoV-2 high-throughput system, three direct RT-qPCR kits, and reverse transcription-loop-mediated isothermal amplification (RT-LAMP). The viral antigen was detected by a rapid antigen immunochromatographic assay. Of the 103 samples, viral RNA was detected in 50.5 to 81.6% of the specimens by molecular diagnostic tests, and an antigen was detected in 11.7% of the specimens by the rapid antigen test. Viral RNA was detected at significantly higher percentages (65.6 to 93.4%) in specimens collected within 9 days of symptom onset than in specimens collected after at least 10 days of symptoms (22.2 to 66.7%) and in specimens collected from asymptomatic patients (40.0 to 66.7%). Self-collected saliva is an alternative specimen option for diagnosing COVID-19. The RT-qPCR LDT, a cobas SARS-CoV-2 high-throughput system, direct RT-qPCR kits (except for one commercial kit), and RT-LAMP showed sufficient sensitivities in clinical use to be selectively used in clinical settings and facilities. The rapid antigen test alone is not recommended for an initial COVID-19 diagnosis because of its low sensitivity.
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Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Inmunoensayo , Técnicas de Amplificación de Ácido Nucleico , Neumonía Viral/diagnóstico , Saliva/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antígenos Virales/análisis , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/normas , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Femenino , Humanos , Inmunoensayo/métodos , Inmunoensayo/normas , Inmunoensayo/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Técnicas de Amplificación de Ácido Nucleico/métodos , Técnicas de Amplificación de Ácido Nucleico/normas , Técnicas de Amplificación de Ácido Nucleico/estadística & datos numéricos , Pandemias , ARN Viral/análisis , ARN Viral/genética , SARS-CoV-2 , Sensibilidad y Especificidad , Manejo de Especímenes , Adulto JovenRESUMEN
BACKGROUND: Non-parasitic splenic cysts are associated with elevated serum carbohydrate antigen (CA) 19-9 levels. We report a case in which a 23-year-old female exhibited a large ruptured splenic cyst and an elevated serum CA19-9 level. CASE PRESENTATION: The patient, who experienced postprandial abdominal pain and vomiting, was transferred to our hospital and was found to have a large splenic cyst during an abdominal computed tomography (CT) scan. On physical examination, her vital signs were stable, and she demonstrated rebound tenderness in the epigastric region. An abdominal CT scan revealed abdominal fluid and a low-density region (12 × 12 × 8 cm) with enhanced margins in the spleen. The patient's serum levels of CA19-9 and CA125 were elevated to 17,580 U/mL and 909 U/mL, respectively. A cytological examination of the ascitic fluid resulted in it being categorized as class II. Finally, we made a diagnosis of a ruptured splenic epidermoid cyst and performed laparoscopic splenic fenestration. The patient's postoperative course was uneventful, and she was discharged on postoperative day 5. The cystic lesion was histopathologically diagnosed as a true cyst, and the epithelial cells were positive for CA19-9. Follow-up laboratory tests performed at 4 postoperative months showed normal CA19-9 (24.6 U/L) and CA125 (26.8 U/L) levels. No recurrence of the splenic cyst was detected during the 6 months after surgery. CONCLUSION: Laparoscopic fenestration of a ruptured splenic cyst was performed to preserve the spleen, after the results of abdominal fluid cytology and MRI were negative for malignancy.
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Antígeno CA-19-9/sangre , Quiste Epidérmico/cirugía , Laparoscopía/métodos , Enfermedades del Bazo/cirugía , Dolor Abdominal/etiología , Femenino , Humanos , Imagen por Resonancia Magnética , Periodo Posoperatorio , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
A 30-year-old female was referred to our hospital for further examination of liver dysfunction. A huge, soft mass was noted in her left upper quadrant on physical examination. Abdominal ultrasonography and computed tomography revealed a huge cystic tumor of 20 cm in the hilus of the spleen. Serum CA19-9 was 491 U/ml, and splenectomy was performed under suspicion of a malignant cystic tumor. The inner surface of the cyst was lined by squamous epithelial cells that were immunohistochemically positive for CA19-9. Serum CA19-9 level was normalized after the surgery. Our case of a very rare, huge epidermoid cyst of the spleen suggests that measurement of the serum CA19-9 level is useful for evaluating therapeutic efficacy of a splenic epidermoid cyst.
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Antígeno CA-19-9/sangre , Quiste Epidérmico/sangre , Enfermedades del Bazo/sangre , Adulto , Quiste Epidérmico/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Imagen Multimodal , Enfermedades del Bazo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) in early gastric cancer has rapidly come into widespread use. However, since complications such as bleeding and perforation often occur, and the procedure time is longer for ESD than endoscopic mucosal resection (EMR), development of safer and more reliable technique is required. PATIENTS AND METHODS: The subjects comprised 45 patients with lesions diagnosed histologically as early gastric cancer. They were divided into three groups: cross-counter technique group (CC, n = 15), peroral traction-assisted ESD with suture material group (PT, n = 15), and no-traction group (NT, n = 15). ESD was carried out by two endoscopists who had experienced fewer than 30 cases of ESD. To compare safety and efficacy of a new traction method (CC group) for ESD in early gastric cancer with other methods (PT group and NT group), procedure time, dissected area per unit time, complete resection rate, perforation rate, and bleeding rate were evaluated. RESULTS: There was no significant difference among these three groups in terms of complications, complete resection rate or procedure time. The dissection area per unit time was 22.4, 15.7, and 13.5 mm(2)/min in the CC, PT, and NT groups, respectively, and there was a significant difference between the CC and NT groups (p = 0.007). CONCLUSIONS: The cross-counter technique shortened the treatment time for endoscopists without abundant experience in gastric ESD, and it is considered a useful method to institute in order to introduce ESD.
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Gastroscopía/métodos , Neoplasias Gástricas/cirugía , Anciano , Anciano de 80 o más Años , Intervención Médica Temprana , Diseño de Equipo , Femenino , Mucosa Gástrica/cirugía , Gastroscopios , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A 62-year-old man was referred to our hospital with enlargement of mucosa-associated lymphoid tissue (MALT) lymphoma of the rectum after the eradication of Helicobacter pylori. The patient was given a diagnosis of stage I MALT. Endoscopic observation revealed an enlarged rectal tumor with 3, 18 double trisomy. Rituximab monotherapy was given and complete remission was achieved. Rituximab monotherapy can be useful for MALT lymphoma of the rectum.
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Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos/uso terapéutico , Cromosomas Humanos 1-3 , Cromosomas Humanos 16-18 , Linfoma de Células B de la Zona Marginal/tratamiento farmacológico , Neoplasias del Recto/tratamiento farmacológico , Trisomía , Anticuerpos Monoclonales de Origen Murino , Humanos , Masculino , Persona de Mediana Edad , Inducción de Remisión , RituximabRESUMEN
BACKGROUND: Indocyanine green (ICG) is a fluorescent marker that is excited by rays at a wavelength of 768 nm to emit fluorescence at a wavelength of 807 nm in the infrared (IR) range. We developed an IR fluorescence endoscope (IRFE) to observe superficial gastric tumors and assessed its clinical usefulness. OBJECTIVE: To evaluate the clinical usefulness of an IRFE for the assessment of superficial gastric tumors. DESIGN: An observational study. SETTING: University hospital. INTERVENTIONS: Newly developed IRFE. PATIENTS: Thirty patients with gastric tumors were enrolled in this study, and their lesions were subjected to endoscopic submucosal dissection (ESD), or laparoscopic gastrectomy after observation with the IRFE. METHODS: Gastric lesions were subjected to conventional observation, followed by IR fluorescence observation before and after intravenous ICG (0.01 mg/kg) injection. MAIN OUTCOME MEASUREMENTS: The relationship between the positive fluorescence and invasivity of each tumor. RESULTS: Fluorescence was positive in 8 of 10 gastric cancers with submucosal invasion (80%) and 1 of 20 adenomas or intramucosal gastric cancers (5%); the difference was statistically significant (P<.01). CONCLUSION: IRFE is a useful diagnostic tool for estimating the invasivity of gastric tumors.
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Adenocarcinoma/patología , Adenoma/patología , Endoscopía Gastrointestinal/métodos , Fluorescencia , Rayos Infrarrojos , Neoplasias Gástricas/patología , Adenocarcinoma/cirugía , Adenoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colorantes , Endoscopios Gastrointestinales , Diseño de Equipo , Femenino , Humanos , Verde de Indocianina , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Neoplasias Gástricas/cirugíaRESUMEN
The present study evaluated correlations between preoperative bile juice cytology and mucin expression of surgical specimens in biliary tract carcinoma. Twenty-five patients with biliary tract carcinoma surgically treated at our hospital, whose bile juice cytology had been evaluated before operation, were allocated to this study. Biliary cytology was classified into three categories based on the Papanicolaou classification. Immunohistochemical staining of tissues was performed using MUC1 and MUC2 monoclonal antibodies. Lesions showing MUC1 expression of ++ or higher and MUC2 expression of - were classified as Group A, and the remaining lesions as Group B. According to the epithelial site, preoperative cytology was highly correlated in Group A, while it was negative in Group B (p<0.05). In the advanced site of carcinomas, preoperative cytology tended to highly be positive in Group A, while it tended to be negative in Group B (p<0.05). These results suggest that the bile juice cytology results are affected by characteristics of mucin expression in the tissue. Based on the possibility that mucin expression correlates with the prognosis of each carcinoma, a positive cytological result suggests a poor prognosis for the carcinoma, which may be informative for predicting the post-operative courses and choosing treatments.
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Antígenos de Neoplasias/análisis , Bilis/citología , Neoplasias del Sistema Biliar/química , Neoplasias del Sistema Biliar/patología , Mucinas/análisis , Adulto , Anciano , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Mucina-1 , Mucina 2RESUMEN
Humoral hypercalcemia of malignancy (HHM) in neoplastic syndrome has been most commonly reported in squamous cell carcinoma. Gallbladder carcinoma with HHM is uncommon. In this report, we describe a male case of gallbladder carcinoma with marked hypercalcemia and a high level of serum parathyroid hormone-related peptide (PTHrP). An immunohistochemical examination using PTHrP was also positive.
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Adenocarcinoma/metabolismo , Neoplasias de la Vesícula Biliar/metabolismo , Hipercalcemia/etiología , Proteína Relacionada con la Hormona Paratiroidea/biosíntesis , Adenocarcinoma/complicaciones , Neoplasias de la Vesícula Biliar/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Proteína Relacionada con la Hormona Paratiroidea/sangreRESUMEN
Since there is no infrared fluorescence materials in the living body, infrared fluorescence labeling materials are very useful for making a diagnosis of a micro cancer. We have developed an infrared fluorescence endoscope (IRFE) and indocyanin green (ICG)-derivative as infrared fluorescence labeling materials to evaluate gastrointestinal neoplastic lesions. The study aims were to apply an IRFE and to demonstrate its usefulness in detecting cancerous tissue using an antibody coupled with ICG-derivative. IRFE consisted of an infrared endoscope equipped with excitation (710-790 nm) and barrier (810-920 nm) filters and an intensified CCD camera. We have developed ICG N-hydroxy sulfo succinimide ester (ICG-sulfo-OSu) and 3-ICG-acyl-1, 3-thiazolidine-2-thione (ICG-ATT) as an infrared fluorescent-labeling reagent. ICG-derivative-labeled mouse anti-human carcinoembryonic antigen (CEA) antibody and MUC1 antibody were employed in this study. Moreover, we examined the ability of a reinforcement agent, octylglucoside, to intensity fluorescence from the labeled antibody. Biopsy specimens of gastric cancer were stained with anti-CEA antibody by the avidin-biotinylated peroxidase complex method. Among the positive specimens, freshly resected stomach from three cases were used for the infrared (IR) imaging analysis. The incubation of freshly resected stomach specimens with ICG-anti-CEA antibody-complex resulted in positive staining of the tumor sites by IRFE, and the IR fluorescent images correlated well with the tumor sites. The immunohistochemical studies suggested that the intensity of IR fluorescence of ICG-ATT-MUC1 was stronger than that of ICG-sulfo-OSu. In tumor sections, the reinforcement agent intensified fluorescence, ever at low antibody concentrations. Therefore, we conclude that an anti-CEA (and/or MUC1) antibody with affinity for cancerous lesions and labeled with ICG-derivative can be imaged with this IRFE. Specific antibodies tagged with ICG-derivative with the reinforcement agent can label cancer cells and generate a strong enough fluorescent signal to detect small cancers when examined with an IR fluorescence endoscope.
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Endoscopía Gastrointestinal/métodos , Neoplasias Gastrointestinales/diagnóstico , Animales , Anticuerpos Antineoplásicos , Antígenos de Neoplasias , Antígeno Carcinoembrionario/inmunología , Colorantes Fluorescentes , Humanos , Verde de Indocianina/análogos & derivados , Rayos Infrarrojos , Ratones , Mucina-1 , Mucinas/inmunologíaRESUMEN
PURPOSE: In recent years, labeled antibodies have been used for diagnostic imaging in many studies. In this study, we investigated the mode of binding in antibodies labeled with ICG derivatives newly developed for the diagnosis of microcarcinomas, and evaluated the optimal binding molar ratio between the labeling compounds and antibody. METHODS: MUC 1 antibody and ICG derivatives (ICG-ATT and ICG-sulfo-OSu) were used. ICG derivatives non-covalently bound to the antibody were removed with ethyl acetate, and the ratio of ICG derivatives covalently bound to the labeled antibody was confirmed. During purification of the labeled antibody, the amount of each labeling compound reacting with 1 molecule of the antibody varied as follows: 4, 8, 16, and 32 molar equivalents. Subsequently, the intensity of fluorescence was evaluated by spectroscopy and infrared fluoroscopy. RESULTS: The ratio of residual ICG derivative labeling the antibody was 67.4% for ICG-ATT and 65.0% for ICG-sulfo-OSu. When fluorescent antibody labeled with ICG-ATT at an F/P ratio of 2.94 or 4.18 was used, specific and clear fluorescent images of the antigen were obtained. When ICG-ATT-labeled antibody at an F/P ratio of 6.50 or 6.75 was used, the fluorescence intensity decreased and the fluorescent images of antigen became unclear. CONCLUSIONS: It was found that the ICG-ATT-labeled antibody was a more specific and sensitive marker than ICG-sulfo-OSu-labeled antibody, and that lower binding molar ratios of ICG-ATT were more useful for labeling the antibody.
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Anticuerpos Antineoplásicos , Endoscopía/métodos , Antígenos de Neoplasias , Técnica del Anticuerpo Fluorescente/métodos , Colorantes Fluorescentes , Gastroscopía/métodos , Humanos , Verde de Indocianina , Rayos Infrarrojos , Mucina-1 , Mucinas/inmunología , Neoplasias Gástricas/diagnósticoRESUMEN
Activation of leukocytes plays an essential role in the mechanism of restenosis. Prior research has focused on monocytes and little is known about the role of neutrophils in this process. Neutrophils are known to contribute to tissue injury through oxygen-derived free radicals that nitrate tyrosine. This study was designed to elucidate clinically the role of neutrophil-mediated oxidative burst in the regulation of the post-stent inflammatory process. In 36 patients undergoing coronary stenting, we serially measured serum levels of glycosyl-phosphatidil-inositol-anchored protein (GPI)-80,a modulator of Mac-1 on the surface of neutrophils, in samples of coronary sinus as well as peripheral blood. We also simultaneously measured the serum 3-nitrotyrosine/tyrosine ratio as an index of oxidative stress. The GPI-80 level and the 3-nitrotyrosine/tyrosine ratio increased in the coronary sinus after coronary stenting in a time-dependent manner; with the maximum increase of GPI-80 level (3.1 +/- 2.9 to 8.6 +/- 4.3 ng/ml, P < 0.01) at 48 hours, and 3-nitrotyrosine/tyrosine ratio at 24 hrs (5.2 +/- 4.8 to 28.4 +/- 13.2 x 10(-4), P < 0.01), more strikingly than in the peripheral blood. In the coronary sinus blood, the 3-nitrotyrosine/tyrosine ratio was correlated with GPI-80 levels at 24 hr (R = 0.58, P < 0.001) and at 48 hr (R = 0.41, P < 0.01). Multiple regressions analysis showed that the maximum responses of GPI-80 level and 3-nitrotyrosine/tyrosine ratio were independent predictors of angiographic late lumen loss. Our results may support a hypothesis that Mac-1-dependent activation of neutrophils causes oxidative burst in the post-stent inflammatory process, possibly leading to restenosis.
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Angioplastia Coronaria con Balón , Enfermedad de la Arteria Coronaria/terapia , Reestenosis Coronaria/patología , Neutrófilos/patología , Stents/efectos adversos , Túnica Íntima/patología , Amidohidrolasas , Moléculas de Adhesión Celular/sangre , Reestenosis Coronaria/sangre , Reestenosis Coronaria/etiología , Vasos Coronarios/patología , Femenino , Proteínas Ligadas a GPI , Humanos , Hidrolasas , Inflamación/sangre , Inflamación/etiología , Inflamación/patología , Masculino , Activación Neutrófila , Análisis de Regresión , Estallido Respiratorio , Factores de Tiempo , Tirosina/análogos & derivados , Tirosina/sangreRESUMEN
BACKGROUND: In previous studies, we generated infrared ray fluorescence-labeled monoclonal antibodies and developed an infrared ray fluorescence endoscope capable of detecting the monoclonal antibodies to establish a novel diagnostic technique for gastrointestinal cancer. Although the whole IgG molecule has commonly been used for preparation of labeled antibodies, labeled IgG displays insufficient sensitivity and specificity, probably resulting from non-specific binding of the Fc fragment to target cells or interference between fluorochromes on the identical labeled antibody, which might be caused by molecular structure. In this in vitro study, we characterized an Fc-free fluorescence-labeled Fab fragment, which was expected to yield more specific binding to target cells than the whole IgG molecule. METHODS: An anti-mucin antibody and ICG-ATT, an ICG derivative, were used as the labeled antibody and labeling compound, respectively. Paraffin sections of excised gastric cancer tissues were subjected to staining. The labeled whole IgG molecule (ICG-ATT-labeled IgG) and the labeled Fab fragment (ICG-ATT-labeled Fab) were prepared according to a previous report, and the fluorescence properties, antibody activities, and features of fluorescence microscope images obtained from paraffin sections were compared. RESULTS: Both ICG-ATT-labeled Fab and ICG-ATT-labeled IgG were excited by a near infrared ray of 766nm, and maximum emission occurred at 804nm. Antibody activities of ICG-ATT-labeled Fab were shown to be similar to those of unlabeled anti-MUC1 antibody. The fluorescence intensity obtained from paraffin sections of excised gastric cancer tissues revealed a tendency to be greater with ICG-ATT-labeled Fab than with ICG-ATT-labeled IgG. CONCLUSIONS: The infrared ray fluorescence-labeled Fab fragment was likely to be more specific than the conventionally labeled antibodies. Fragmentation of antibodies is considered to contribute to improved sensitivity and specificity of labeled antibodies for detection of micro gastrointestinal cancers.
RESUMEN
Mucin core proteins are known to be present in various organs and are specifically expressed with carcinogenesis and closely associated with the prognoses of various malignant tumors in the digestive tract such as colorectal cancer. The present study evaluated correlations between mucin and p53 expression and prognosis of gallbladder cancer using surgically resected tissue specimens from 26 patients with gallbladder carcinoma surgically treated at our hospital. Immunohistochemical staining was performed using MUC 1, MUC2, and p53 monoclonal antibody. The level of antigen expression in the lesion was classified into four stages: none(-), slight(+), moderate (++), and severe (+ + +). According to the UICC classification, histopathological grading, levels of T, N, and M factors, and tumor stages were compared with regard to the correlations with mucin and p53 expression. All cases were classified into two groups according to the results of mucin immunohistochemistry: group A (MUC1, > or = ++; and MUC2, < or = +) and group B (MUC1, < ++; or MUC2, > +). Postoperative survival periods were compared between the two groups and p53-positive and -negative groups. Neither histological grading nor T factor correlated with mucin or p53 expression, respectively. Moreover, neither N factor nor M factor correlated with mucin or p53 expression. Furthermore, stage grouping did not correlate with mucin or p53 expression. However, when the correlation between the postoperative survival period and mucin expression was evaluated, the mean postoperative surgical period was significantly shorter in Group A than in Group B (1.02 years in Group A vs 2.92 years in Group B; P = 0.016). There was no relationship between postoperative survival period and p53 positivity. Mucin expression was independent of various tumor growth factors and clearly reflected the prognosis of gallbladder cancer. Because the relative malignancy of gallbladder cancer could be evaluated by examining the level of glycoprotein expression in tumor tissue, mucin could be a more important marker than p53 for predicting prognosis in gallbladder carcinoma using surgically resected tissue specimens.
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Carcinoma/metabolismo , Neoplasias de la Vesícula Biliar/metabolismo , Mucinas/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Anciano , Carcinoma/mortalidad , Carcinoma/patología , Femenino , Neoplasias de la Vesícula Biliar/mortalidad , Neoplasias de la Vesícula Biliar/patología , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Pronóstico , Tasa de SupervivenciaRESUMEN
OBJECTIVES: The purpose of this study was to assess local release of C-reactive protein (CRP) from atherosclerotic plaques or the vessel wall injured by stenting. BACKGROUND: Recent research has focused on the local production of CRP, especially in inflammatory atherosclerotic plaques. METHODS: The study consisted of two separate protocols. In protocol 1, we measured serum high-sensitivity-CRP (hs-CRP) levels in coronary arterial blood sampled just distal and proximal to the culprit lesions in 36 patients with stable angina and 13 patients with unstable angina. In protocol 2, we measured serial serum hs-CRP levels and activated Mac-1 on the surface of neutrophils in both coronary sinus and peripheral blood in 20 patients undergoing coronary stenting. RESULTS: In protocol 1, CRP was higher in distal blood than proximal blood in both stable (p < 0.05) and unstable angina (p < 0.01). The translesional CRP gradient (distal CRP minus proximal CRP, p < 0.05) as well as the proximal CRP (p < 0.05) and distal CRP (p < 0.05) was higher in unstable angina than in stable angina. In protocol 2, the transcardiac CRP gradient (coronary sinus minus peripheral blood) and activated Mac-1 increased gradually after stenting, reaching a maximum at 48 h (p < 0.001 vs. baseline for both). There was a positive correlation between the transcardiac CRP gradient and activated Mac-1 at 48 h (r = 0.45, p < 0.01). CONCLUSIONS: C-reactive protein is an excellent marker for plaque instability or poststent inflammatory status, and its source might be the inflammation site of the plaque or the coronary arterial wall injured by stenting.
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Angina de Pecho/metabolismo , Angina Inestable/metabolismo , Proteína C-Reactiva/metabolismo , Enfermedad de la Arteria Coronaria/metabolismo , Vasos Coronarios/lesiones , Stents , Anciano , Angina de Pecho/sangre , Angina Inestable/sangre , Protocolos Clínicos , Enfermedad de la Arteria Coronaria/sangre , Reestenosis Coronaria/etiología , Vasos Coronarios/metabolismo , Femenino , Humanos , Antígeno de Macrófago-1/metabolismo , Masculino , Persona de Mediana Edad , Neutrófilos/metabolismo , Análisis de RegresiónRESUMEN
OBJECTIVES: The aim of this study was to confirm clinically a hypothesis that cilostazol inhibits leukocyte Mac-1, leading to prevention of post-stent restenosis. BACKGROUND: The platelet phosphodiesterase III inhibitor called cilostazol also inhibits alpha-granule release of P-selectin in platelets. The P-selectin-mediated platelet-leukocyte interaction promotes activation and upregulation of leukocyte Mac-1 after coronary stenting, which plays a key role on the mechanism of restenosis. Thus, cilostazol's potential inhibition of this process may lead to prevention of restenosis. METHODS: Using flow cytometric analysis of whole blood obtained from the coronary sinus, the expression of platelet membrane glycoproteins and neutrophil adhesion molecules was observed in 70 consecutive patients undergoing coronary stenting. The patients were randomly assigned to either a cilostazol or ticlopidine group before stent placement. RESULTS: The restenosis rate was lower (15% vs. 31%, p < 0.05) in the cilostazol group (n = 34) than in the ticlopidine group (n = 32). A stent-induced increase in platelet P-selectin (CD62P) expression and an increase in neutrophil Mac-1 (CD11b) expression were suppressed in the cilostazol group compared with the ticlopidine group. Angiographic late lumen loss was correlated with the relative changes in platelet P-selectin and neutrophil Mac-1 at 48 h after coronary stenting. CONCLUSIONS: Cilostazol may have effects on suppression of P-selectin-mediated platelet activation, platelet-leukocyte interaction, and subsequent Mac-1-mediated leukocyte activation, which might lead to a reduced restenosis rate after coronary stent implantation.
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Enfermedad de la Arteria Coronaria/terapia , Reestenosis Coronaria/prevención & control , Leucocitos/efectos de los fármacos , Antígeno de Macrófago-1/efectos de los fármacos , Activación Plaquetaria/efectos de los fármacos , Stents , Tetrazoles/uso terapéutico , Ticlopidina/uso terapéutico , 3',5'-AMP Cíclico Fosfodiesterasas/antagonistas & inhibidores , Anciano , Cilostazol , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Reestenosis Coronaria/sangre , Fosfodiesterasas de Nucleótidos Cíclicos Tipo 3 , Femenino , Citometría de Flujo , Humanos , Leucocitos/metabolismo , Masculino , Persona de Mediana Edad , Neutrófilos/efectos de los fármacos , Selectina-P/sangre , Selectina-P/efectos de los fármacos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Proyectos de Investigación , Stents/efectos adversos , Tetrazoles/farmacología , Ticlopidina/farmacologíaRESUMEN
A 64-year-old man with a chief complaint of melena visited our emergency outpatient clinic. After several examinations, he was diagnosed as a gastrointestinal stromal tumor (GIST) with liver metastasis. Surgical resection of the jejunal lesion and postoperative adjuvant therapy with STI571 for one year was performed. Due to recent immunohistological studies and introduction of STI571, the diagnosis, treatment, and prognosis of GIST are about to change profoundly. Further accumulation of cases is necessary to investigate the diagnosis, treatment, and prognosis of GIST.