Bradykinin mediated gastrointestinal edema as a cause of abdominal attacks in patients with hereditary angioedema due to C1-inhibitor deficiency.

Hereditary angioedema (HAE) due to C1-inhibitor (C1-INH) deficiency is a rare hereditary disease characterized by recurrent subcutaneous or submucosal angioedema due to uncontrolled bradykinin production caused by C1-INH dysfunction. Submucosal gastrointestinal swellings provoking abdominal attacks are common and mimic acute abdomen, thus constituting a diagnostic challenge. We aimed to investigate the difficulties in diagnosing abdominal attacks in patients with C1-INH-HAE and to assess the diagnostic value of medical history, the course of the attack, abdominal imaging, and treatment efficacy. The retrospective analysis of diagnostic problems and treatment complications of abdominal attacks in 274 patients with C1-INH-HAE were performed. The value of history, laboratory findings, prodromal symptoms and course of attacks and imaging were assessed. Abdominal attacks were confirmed in 274 of the 322 patients (85%; 190 women and 84 men; age, 4-70 years). In 49% of cases, the abdominal attack was the first and the only symptom for years. The simultaneous presence of marginal erythema (45% of cases), subcutaneous edema (30%), and pharyngo-laryngeal edema (10%) facilitated the diagnosis of an abdominal attack due to C1-INH-HAE. Abdominal attacks manifested with recurrent acute abdominal symptoms lasting 2 to 5 days. The disease course was characterized by the phase of progressive prodromal symptoms followed by peak symptoms and spontaneous symptom resolution. Abdominal imaging often revealed abundant ascites and limited bowel edema. In 60 cases (22%), the diagnostic difficulties resulted in exploratory laparotomy, which was inconclusive in 48 patients (80%). The attacks usually subsided within 2 hours from the administration of recommended drugs (plasma-derived C1-INH, recombinant C1-INH or icatibant). We conclude that recurrent abdominal attacks lasting a few days and resolving spontaneously were common symptoms of C1-INH-HAE. Abdominal imaging revealed transitional fluid or bowel edema. The effectiveness of recommended drugs as plasma-derived C1-INH, recombinant C1-INH or icatibant confirmed the diagnosis.

The Internal Cerebral Vein: New Classification of Branching Patterns Based on CTA.

BACKGROUND AND PURPOSE: The internal cerebral vein begins at the foramen of Monro by the union of the thalamostriate and the anterior septal veins. The lateral direct vein is its other major tributary. Numerous researchers have reported differences in internal cerebral vein branching patterns but did not classify them. Hence, the objectives of this study were to evaluate the anatomy of the internal cerebral vein and its primary tributaries and classify them depending on their course patterns using CTA. MATERIALS AND METHODS: Head CTAs of 250 patients were evaluated in this study, in which we identified the number and termination of the anterior septal vein and the lateral direct vein. The course of the lateral direct vein and its influence on the number of thalamostriate veins and their diameters and courses were assessed. The anterior septal vein-internal cerebral vein junctions and their locations in relation to the foramen of Monro also were evaluated. RESULTS: We classified internal cerebral vein branching patterns into 4 types depending on the presence of an extra vessel draining the striatum. Most commonly, the internal cerebral vein continued further as 1 thalamostriate vein (77%). The lateral direct veins were identified in 22% of the hemispheres, and usually they terminated at the middle third of the internal cerebral vein (65.45%). The most common location of the anterior septal vein-internal cerebral vein junction was anterior (57.20%), with the anterior septal vein terminating at the venous angle. CONCLUSIONS: Detailed knowledge of the anatomy of the deep cerebral veins is of great importance in neuroradiology and neurosurgery because iatrogenic injury to the veins may result in basal nuclei infarcts. A classification of internal cerebral vein branching patterns may aid clinicians in planning approaches to the third and lateral ventricles.

Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings.

BACKGROUND: Anatomical variations of the middle cerebral artery (MCA) are an important clinical issue, due to high prevalence of intracranial aneurysms. Anatomical variations of vessels can lead to higher shear stress, which is thought to be the main factor leading to aneurysm formation and consequently to higher prevalence of aneurysms. The aim of this study was to evaluate anatomy of the MCA; to classify MCA aneurysms using computed tomography angiography and to correlate anatomical variations of MCA and circle of Willis with prevalence of MCA aneurysms. MATERIALS AND METHODS: Two hundred and fifty patients without MCA aneurysms and 100 patients with unruptured MCA aneurysms were qualified for the study, with exclusion of patients after MCA clipping. Four aspects of MCA anatomy were evaluated: division point, its relation to the genu, distance to M1 division and the genu and domination of post-division trunks. RESULTS: Middle cerebral artery bifurcation was found in 86.2% and trifurcation in 13.8% of the cases. 78.4% of MCAs divided before the genu, 19.2% in the genu and 2.4% after the genu. Upper branch domination was seen in 26%, lower branch in 25.4%, middle branch in 4% and no domination in 44.6% of the cases. In the study group 116 aneurysms were found. 86.2% of the aneurysms were located in M1 division point, 6.9% in M2 segment, 3.4% near lenticulostriatae arteries and 3.4% near early cortical branches. The only anatomical variation, which had significantly higher prevalence in patients with left MCA aneurysms, was domination of upper post-division trunk of MCA. No other statistically significant differences in circle of Willis and MCA variations were found between patients with aneurysms and without them. CONCLUSIONS: The most common configuration of MCA is bifurcation before the genu with no dominating post-division trunk. Incidence of MCA aneurysms is not correlated with anatomical variations of MCA and the circle of Willis.

Analysis of the intensity of immune cell infiltration and immunoreactivity of RCAS1 in diffuse large B-cell lymphoma of the palatine tonsil and its microenvironment.

Non-Hodgkin lymphoma of Waldeyer's ring constitutes a small percentage of cases of palatine tonsil malignancies and its precise etiology remains unknown. RCAS1 (receptor cancer-binding antigen expressed on SiSo cells) has been demonstrated to be associated with poor prognosis, the development of lymph node metastases and participation in tumor microenvironment remodeling. Our aim is to analyze the potential role of RCAS1 expression in the tumor and tumor microenvironment in the development of early-stage palatine tonsil B-cell lymphomas. We selected 20 patients and analyzed tissue samples from the lymphoma and tumor microenvironment of each patient and from a reference group of 20 patients with chronic tonsillitis. The presence of RCAS1 protein immunoreactivity was demonstrated in 65% of the examined tissue samples of diffuse large B-cell lymphoma and in 25% of the analyzed stromata in which it was exhibited by CD68-positive cells identified as macrophages and dispersed throughout the stroma. RCAS1 immunoreactivity in the lymphoma tissue samples remained at a level comparable with that of the reference and was significantly higher in these samples than in those from the stroma. Chronic inflammation of the palatine tonsils thus results in intensive infiltration by various types of immune system cells and in excessive RCAS1 immunoreactivity, both of which confirm the important regulatory role of RCAS1 in the immune response in the mucosa-associated lymphatic tissue of Waldeyer's ring. RCAS1 seems to be involved in creating tumor-induced inflammation in the tumor and its microenvironment.

Antisense anti IGF-I cellular therapy of malignant tumours: immune response in cancer patients.

The treatment of cancer by antisense anti-IGF-I cellular therapy inducing immune response has evoked interest among many promising strategies. Here, we reported some results obtained from patients with cancer, mainly glioblastoma treated by this strategy, which was also extended to patients with colon carcinoma, ovary cystadenocarcinoma and prostate adenocarcinoma. It was shown that, in the phase I of clinical trial, patients vaccinated with their own tumour cells treated by antisense IGF-I presented a slight increase of temperature. Their peripheral blood lymphocytes showed a shift in the percentage of CD8 effector cells as judged by expression of cell surface markers CD8+ CD28+. Particularly, in two treated patients with glioblastoma, the survival time was 19 and 24 months respectively in comparison to the range of 12 to 15 months observed in the case of classical treatment such as surgery, radiation or chemotherapy. These results, although preliminary, gave indication that the reported strategy could deserve consideration owing to its safety. Furthermore, the increase in the percentage of peripheral blood monomorphonucleated cells (PBMNCs) with effector phenotype, i.e., CD8+ CD28+ in vaccinated patients might explain their prolonged survival time.

Adjuvant chemotherapy with etoposide, adriamycin and cisplatin compared with surgery alone in the treatment of gastric cancer: a phase III randomized, multicenter, clinical trial.

OBJECTIVE: The aim of this study was to evaluate the efficacy of adjuvant chemotherapy with etoposide, Adriamycin and cisplatin (EAP) after potentially curative resections for gastric cancer. METHODS: After surgery, patients were randomly assigned to the EAP or control arm. Chemotherapy included 3 courses, administered every 28 days. Each cycle consisted of doxorubicin (20 mg/m(2)) on days 1 and 7, cisplatin (40 mg/m(2)) on days 2 and 8, and etoposide (120 mg/m(2)) on days 4, 5, and 6. RESULTS: Of 309 eligible patients, 141 were allocated to chemotherapy and 154 to the supportive care group. Four (2.8%) treatment-related deaths were recorded, including 3 due to septic complications of myelosuppression and 1 due to cardiocirculatory failure. Grade 3 or 4 toxicities were found in 17 (22%) patients. According to the intention-to-treat analysis, the median survival was 41.3 months (95% confidence interval, 24.5-58.2) and 35.9 months (95% confidence interval, 25.5-46.3) in the chemotherapy and control group, respectively (p = 0.398). Subgroup analysis revealed survival benefit from chemotherapy in patients with tumors infiltrating the serosa and in those with 7-15 metastatic lymph nodes. CONCLUSION: Three cycles of EAP regimen postoperatively offer no survival advantage in gastric cancer patients.

Ratio of metastatic to resected lymph nodes for prediction of survival in patients with inadequately staged gastric cancer.

BACKGROUND: Staging is inadequate in up to 70 per cent of patients with gastric cancer in Western countries owing to the small number of lymph nodes dissected during surgery. The aim was to determine whether using the ratio of metastatic to resected lymph nodes (LNR) might improve accuracy. METHODS: Data were analysed from patients with gastric cancer who had gastrectomy in several centres between 1986 and 1998, with dissection of 15 or fewer lymph nodes. LNRs and other prognostic factors were evaluated. RESULTS: From a total of 738 patients, the median number of resected nodes was 8 (range 1-15) and median LNR was 42.8 per cent. The number of metastatic nodes significantly affected survival only in univariable analysis. In a Cox proportional hazards model, patient age, depth of tumour infiltration, tumour location, and LNR were identified as independent prognostic factors. Compared with node-negative patients, the hazard ratio for an LNR of 0.1-40.0 per cent was 1.85 (P < 0.001), increasing to 2.93 (P < 0.001) when the LNR exceeded 40.0 per cent. CONCLUSION: The LNR cannot be used as a substitute for staging with adequate lymphadenectomy. It may help to stratify patients in terms of prognosis when the number of resected lymph nodes is limited.

IGF-I, IGF-II, IGFBP2, IGFBP3 and acid-labile subunit (ALS) in colorectal cancer patients before surgery and during one year follow up in relation to age.

PURPOSE: To investigate the changes of IGF system in colon cancer patients in relation to age, the serum IGF-I, IGF-II, IGFBP2, IGFBP3 and ALS were measured by immunochemistry before surgery, as well as one and six months after surgery. MATERIAL AND METHODS: One hundred and twenty six patients were included into the study: group I (<50 yrs, N=21); group II (50 to <55 yrs, N=16) ; group III (55 to <65 yrs, N=34); group IV (65 to <75 yrs, N=42) and group V (> or =75 yrs, N=13). RESULTS: Before surgery: only the mean value of IGF-I concentration in group I was significantly higher as compared to group V (p<0.01). One month after surgery: 1) a decrease in the mean values of IGF-I, IGF-II, IGFBP3 and ALS levels was observed, but only for IGF-II (groups II-V), IGFBP3 (groups II-V) and ALS (groups III-V) the changes were significant; 2) the mean value of ALS level in group I was higher as compared to group III-V (p<0.05 to 0.02); 3) higher mean values of IGF-I/alb, IGFBP3/alb and ALS/alb were noted for group I as compared to group V (p<0.01 to 0.001); 4) the mean levels of IGFBP2 were significantly lower in group I as compared to groups II, III, IV and V (p<0.001 in all cases). CONCLUSIONS: In colon cancer patients IGF-I, IGFBP3 and ALS decrease with age, but the relation between them exists regardless the patient's age and time of observation. Lower IGFBP2 level together with higher IGF-I might contribute to more aggressive course of disease in colon cancer patients below 50 years of age.

A dose-ranging, placebo-controlled, pilot trial of Acotiamide in patients with functional dyspepsia.

Impaired gastric accommodation, hypersensitivity to distension and delayed gastric emptying are major pathophysiological mechanisms in functional dyspepsia (FD). Acotiamide (Z-338) was well-tolerated in healthy volunteers. To determine the effect of three doses of Acotiamide on major pathophysiological mechanisms, symptoms, quality of life (QOL) and safety in functional dyspeptics. A phase IIa, randomized, double-blind, placebo-controlled study (14, 21 and 28 days, respectively, for run-in, study drug administration and follow-up). Gastric accommodation, sensitivity to distension and gastric emptying were assessed by barostat and (13)C breath test, symptoms by daily diary cards and QOL by SF-36. A total of 71 patients were enrolled (62 evaluable). There was no effect on gastric emptying and sensitivity to distension. 300 mg was better than placebo for meal accommodation (P = 0.024). 100 mg was better than placebo at week 2 for upper abdominal bloating (P = 0.001) and overall symptom score (P = 0.022), and at week 3 for bloating (P = 0.008) and heartburn (P = 0.041). 100 mg was also better than placebo for QOL (physical function) (P = 0.003). Acotiamide was safe and well-tolerated in patients with FD. The involved mechanism could at least in part depend on an effect on meal-induced accommodation. 100 mg Acotiamide exhibited the potential to improve FD symptoms and QOL. Further studies are indicated.

Evaluation of adjuvant chemotherapy irinotecan + 5-fluorouracil + leucovorine in advanced colorectal cancer.

OBJECTIVE: to analyze clinical effectivity of chemotherapy based on Irinotecan, 5-Fluorouracyl and Folinic acid in patients with colorectal carcinoma. METHODS: prospective, randomized, open-label trial in group of 204 patients with advanced colorectal cancer randomized to either chemotherapy with irinotecan+5-FU+leucovorin or supportive care alone (control group) between January 1999--January 2005 was performed. Efficacy and safety of treatment was analysed. RESULTS: Administration of the irinotecan, 5FU, LV regimen to patients with stages II and III significantly improved 5-year survival (81% versus 66% and 66% versus 38%, respectively; p < 0.05). Palliative chemotherapy improved survivals also in stage IV, four patients survived 5 years. Adverse event occurred in 44 of 102 patients (43.1%). CONCLUSIONS: study confirms benefits of irinotecan chemotherapy administered to patients with advanced colorectal cancer. Preliminary data suggests that this chemotherapy regimen should be considered for first-line therapy in the adjuvant and palliative treatment of advanced colorectal cancer.

The effects of preoperative chemotherapy on isolated tumour cells in the blood and bone marrow of gastric cancer patients.

Recent studies in breast cancer suggest that monitoring the isolated tumour cells (ITC) may be used as a surrogate marker to evaluate the efficacy of systemic chemotherapy. In the present study, we have investigated the effects of preoperative chemotherapy on ITC in the blood and bone marrow of patients with potentially resectable gastric cancer. After sorting out the CD45-positive cells, the presence of ITC defined as cytokeratin-positive cells was examined before and after preoperative chemotherapy. The patients received two courses of preoperative chemotherapy with cisplatin (100 mg m(-2), day 1) and 5-fluorouracil (1000 mg m(-2), days 1-5), administered every 28 days. Fourteen of 32 (44%) patients initially diagnosed with ITC in blood and/or bone marrow were found to be negative (responders) after preoperative chemotherapy (P<0.01). The incidence of ITC in bone marrow was also significantly (P<0.01) reduced from 97 (31 of 32) to 53% (17 of 32). The difference between patients positive for ITC in the blood before (n=7, 22%) and after (n=5, 16%) chemotherapy was statistically insignificant. The overall 3-year survival rates were 32 and 49% in the responders and non-responders, respectively (P=0.683). These data indicate that preoperative chemotherapy can reduce the incidence of ITC in patients with gastric cancer.

Intraoperative ultrasonography in detecting and assessment of colorectal liver metastases.

OBJECTIVE: to assess the clinical value of intraoperative ultrasonography (IOUS) in detecting and assessment of liver metastatic tumours in colorectal cancer patients. METHODS: a study is a retrospective analysis of 388 patients operated on for colorectal carcinoma between 1997 and 2004. In all the patients intraoperative ultrasound was performed. The authors analyzed of sensitivity, specificity, PPV, NPV and accuracy of pre- and intraoperative ultrasonography in detecting and staging of colorectal metastatic lesions. RESULTS: Intraoperative ultrasonography showed the highest sensitivity, specificity and accuracy in both, tumor detection (99.1, 98.5 and 98.9%, respectively) and assessment (95.4, 99.5 and 99.1%, respectively). Overall sensitivity of IOUS was significantly better in detection and staging compared with preoperative ultrasonography 91.1 and 72.2%, respectively). CONCLUSIONS: IOUS should be used as routine diagnostic modality in colorectal cancer patients with hepatic metastases or suspected metastases. Transabdominal ultrasonography cannot be used as the only diagnostic tool in the evaluation of liver lesions, but may be helpful in preoperative screening.

Outcome of gastric cancer surgery in elderly patients.

BACKGROUND/AIMS: The aim of the study was to review cases of gastric cancers in elderly adults (70 years of age and older), and compare demographic, clinical, pathologic features and outcomes of surgical treatment with younger patients (below 70 years of age). METHODOLOGY: The analysis included 3431 patients treated for gastric cancer between 1977 and 1998 at eight university surgical centers cooperating for the Polish Gastric Cancer Study Group (PGCSG). Patients were analyzed retrospectively according to data obtained from standardized forms and divided into two groups: group I--patients 70 years of age and over, group II--younger patients. RESULTS: There were no significant differences between these two groups in clinical symptoms at the time of diagnosis and tumor advancement. The incidence of the intestinal type according to Lauren (55.9% vs. 43.9%;p<0.05) and distally-located cancers (40.8% vs. 31.3%; p<0.05) was higher in group I. Total gastrectomies and extended lymph node dissection were performed more often in younger patients. There were no significant differences in postoperative complications between both groups, except the higher incidence of abdominal abscesses in the younger group. The overall 5-year survival was 24% and 35% for group I and II, respectively (p<0.05), and increased to 35% and 53% after radical resections, respectively. However, there were no statistically significant differences in stage-specific survival between both groups. CONCLUSIONS: Surgical resection is the method of choice in the treatment of gastric cancer. Age of the patients is not a contraindication to surgical treatment of gastric cancer.

Metallothionein stroma reaction in tumor adjacent healthy tissue in head and neck squamous cell carcinoma and breast adenocarcinoma.

INTRODUCTION: An accumulation of genetic alterations forming the field of cancerization is an important event for the transformation from normal to cancer cell in multistep carcinogenesis. Histopathologically healthy tumor adjacent tissue might be considered as a cancerization field which is typified by genetic changes required for the development of cancer. Metallothionein (MT) is considered to be a protective and anti-apoptotic protein. The aim of our study was to evaluate the MT expression in head and neck squamous cells carcinoma and breast adenocarcinoma and their histologically healthy adjacent tissue. MATERIALS AND METHODS: We have sampled 29 tissue samples in total derived from head and neck cancers and 29 samples of their clear surgical margins, 33 breast adenocarcinomas and 33 clear surgical margins. Antibody recognizing MT-1 was used for immunohistochemical analysis. RESULTS: MT expression was revealed in 85,7% of head and neck cancers and 94% of breast adenocarcinomas. It was found in all tumor adjacent tissue. MT expression was statistically significantly higher in tumor adjacent tissue than in cancer tissue in cases with the presence of lymph node metastases in both, breast adenocarcinoma and head and neck squamous cell carcinoma. Generally stroma seems to respond to the presence of cancer by the expression of MT, even in tissues which normally do not express MT. CONCLUSIONS: MT might be a normal or protective reaction of healthy adjacent tissue to the presence of tumor.

Changes of maternal ACTH and oxytocinase plasma concentrations during the first trimester of spontaneous abortion.

INTRODUCTION: The labor at term finishes normal pregnancy. Both labor at term and first trimester spontaneous abortion are connected with increasing cytotoxic immune response within decidua. Th1 cytokines including IL-2 and INF-gamma are able to exert an effect on HPA axis and result in ACTH secretion. Oxytocinase serum level during pregnancy rises with the fetal development and arrest of oxytocinase serum growth might indicate the its development impairment, what might result in spontaneous abortion. MATERIAL AND METHODS: The study group consisted of 27 patients with clinical symptoms of missed abortion. A control group consisted of 89 pregnant women, who were successfully treated because of infertility. Immunoassay was used to measure ACTH plasma concentration. Oxytocinase plasma activity was established using l-cystine-di-beta-naphthylamide as a substrate. RESULTS: In the present study, significant increase in ACTH plasma concentration was observed during first trimester of spontaneous abortion. These patients were not characterized by significant increase of oxytocinase plasma level. CONCLUSIONS: The observed ACTH rise during spontaneous abortion might be also related to the alterations at the maternal-fetal interface and the response of HPA axis to the growing cytotoxic activity.

Late complications after antireflux procedures using intraoperative continuous computer-video manometry monitoring.

BACKGROUND: Gastroesophageal Reflux Disease (GERD) is a common non-malignant gastrointestinal disease. The introduction of minimally invasive surgical techniques and the high costs of pharmacotherapy increased the number of patients subjected to surgical antireflux treatment. Furthermore, the use of advanced technique of manometry--including intraoperative video-assisted continuous pressure monitoring--made possible complicated but objective analysis of the pressure profile in the newly created area of gastroesophageal junction. MATERIAL AND METHOD: The current study was conducted in 159 patients. A group consisted of 93 men and 66 women, mean age of 38 years (range 18-72), subjected to antireflux surgery with continuous intraoperative video-assisted manometry of pressure in the newly created gastroesophageal junction (fundoplication wrap). Surgical procedure was individually tailored in each case depending on the motility parameters and GERD etiology. Eighty seven patients (55%) underwent 360 degrees Nissen fundoplication, 17 "floppy" Nissen procedure (11%), 22 Dor hemifundoplication (14%), and 33 Toupet hemifundoplication (21%). RESULTS: Out of the 159 patients subjected to antireflux procedures only 8 (5.0%) developed dysphagia, and 12 (7.5%) recurrent reflux disease. Recurrent reflux symptoms were most frequently caused by the dislocation of the fundoplication wrap. Dysphagia occurred in patients with too tight fundoplication wrap or because of its dislocation with subsequent rotation and angulation that impaired food passage. In some patients objective causes of dysphagia have not been found. In these patients no abnormalities were detected by the postoperative visualising examinations, and mean pressure in the fundoplication wrap did not exceed critical values. In these cases, dysphagia was caused probably by impaired gastric motility. CONCLUSIONS: 1. GERD with multifactor etiology requires individually tailored surgery based on the results of motility studies. 2. Final result depends on appropriate calculations of the intraoperative pressure in the newly created fundoplication wrap. 3. Appropriate fixing of the fundoplication wrap to the diaphragm is very important in order to decrease the rate of GERD recurrences due to wrap dislocation.

Case-control study of lifetime occupational and recreational physical activity and risks of colon and rectal cancer.

Important aspects of the inverse relation between physical activity and colon cancer risk are still under discussion. In 2000-2003, 239 incident cases of colorectal cancer confirmed by histopathology and 239 hospital-based controls, matched by age and gender, were enrolled. In standardized interviews, data on occupational and recreational physical activity for ages 20, 30, 40, 50 and 60 years were collected from 98 colon cancer cases, 141 rectal cancer cases, and from 193 controls. Besides lifestyle and sociodemographic characteristics, a detailed food frequency questionnaire was assessed. In multivariate logistic regression for colon cancer, significant risk reductions for the highest quartile of total physical activity were found for almost all ages. For lifetime mean physical activity, the multivariate odds ratio for the highest quartile was 0.37 [95% confidence interval (CI) 0.17, 0.83]. For lifelong constantly high-exercisers compared with lifelong non-exercisers an odds ratio of 0.26 (95% CI 0.08, 0.84) was estimated. For rectal cancer, no consistent association with physical activity was found. No confounding effects were observed but the authors found effect modification with total energy intake. These data support an inverse association of colon cancer risk and physical activity which is most expressed if activity is kept up throughout life.

The value of imaging techniques in the staging of pancreatic cancer.

BACKGROUND: The aim of this study was to assess the clinical value of endoscopic ultrasound (EUS) in the staging of pancreatic carcinoma and to compare it to ultrasonography (US) and CT. METHODS: We evaluated 45 patients (21 women and 24 men with a mean age of 62.1 years) who had undergone surgical treatment for pancreatic cancer between 1994 and 2004. Out analysis focused on the overall accuracy, sensitivity, and specificity of routine and Doppler US, CT, and EUS. RESULTS: Endoscopic ultrasound was the most accurate modality for local tumor staging (93.1%), vascular infiltration (90%), and lymph node assessment (87.5%). Routine US was the least accurate (82.5%, 67.5%, and 72.5%, respectively). The accuracy rates for CT and Doppler US were similar (88.1%, 82.5% and 80.0%, respectively). CONCLUSIONS: Endoscopic ultrasound is the most accurate method available to stage pancreatic cancer in the preoperative period. However, the advantage of EUS over CT and US does not justify its routine use due to its high cost, low availability, and invasiveness.

The value of modern ultrasonographic techniques and computed tomography in detecting and staging of pancreatic carcinoma.

OBJECTIVE: to assess the clinical value of ultrasonographic methods and computed tomography in diagnosing and staging pancreatic carcinoma. METHODS: prospective clinical trial of 140 patients (64 women and 77 men; mean age 59,6) operated on for pancreatic carcinoma between 2000 and 2004. In each case helical CT, routine-, color- and power Doppler and 3-D USG were performed to detect and stage cancer. Analyses of accuracy, sensitivity, specificity, PPV and NPV of ultrasonographic methods and CT were made. RESULTS: 3-D USG showed the best accuracy of local staging (T): 95.6%. CT was the most accurate in lymph node assessment: 91.3%. The accuracy of CT, 3-D USG and power-Doppler at detecting vascular infiltration was 93.1%. CONCLUSIONS: diagnostic accuracy of modern ultrasound techniques is comparable to helical CT in detecting and staging pancreatic carcinoma. USG is recommended due to the relatively low cost, non-invasiveness and availability of the procedure.

IGF-I triple helix gene therapy of rat and human gliomas.

PURPOSE: IGF-I anti-gene technology was applied in treatment of rat and human gliomas using IGF-I triple helix approach. MATERIAL AND METHODS: CNS-1 rat glioma cell and primary human glioblastoma cell lines established from surgically removed glioblastomas multiforme were transfected in vitro with IGF-I antisense (pMT-Anti-IGF-I) or IGF-I triple helix (pMT-AG-TH) expression vectors. The transfected cells were examined for immunogenicity (immunocytochemistry and flow cytometry analysis) and apoptosis phenomena (electron microscopy). 3 x 10(6) transfected cells were inoculated subcutaneously either into transgenic Lewis rats or in patients with glioblastoma. The peripheral blood lymphocytes (PBL) derived from "vaccinated" patients were immunophenotyped for the set of CD antigens (CD4, CD8 etc). RESULTS: Using immunocytochemistry and Northern blot techniques, the transfected "antisense" and "triple-helix" cells showed total inhibition of IGF. Transfected cultures were positively stained either for both MHC-I and B7 antigens--60% of cloned lines, or for MHC-I only--40% of cloned lines. Moreover "triple helix" cells as compared to "antisense" cells showed slightly higher expression of MHC-I or B7. Transfected cells also showed the feature of apoptosis in 60%-70% of cells. In in vivo experiments with rats bearing tumors, the injection of "triple helix" cells expressing both MHC-I and B7 interrupted tumor growth in 80% of cases. In contrast, transfected cells expressing only MHC-I stopped development in 30% of tumors. In five patients with surgically resected glioblastoma who were inoculated with "triple helix" cells, PBL showed an increased percentage of CD4 + CD25+ and CD8 + CD11b-cells, following two vaccinations. CONCLUSIONS: The anti-tumor effectiveness of IGF-I anti-gene technology may be related to both MHC-I and B7 expression in cells used for therapy. The IGF-I antigene therapy of human glioblastoma multiforme increases immune response of treated patients.