RESUMO
AIM: To evaluate circulating endothelial lineage cells (ELCs) as biomarkers of tumor neovascularization in patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS: ELCs were isolated from the peripheral blood of patients with PDAC (n=14) or controls (n=17) before and after tumor resection/surgery and quantified using flow cytometry. Vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) were detected in tumor using immunohistochemistry and in plasma using an ELISA technique. RESULTS: Circulating ELC levels were increased in patients with PDAC compared to controls. After PDAC resection, ELC levels declined. ELC level increases were associated with cancer recurrence. VEGF and PlGF were identified in cancer cells and exocrine pancreas cells. Only PlGF was detected in tumor-associated inflammatory cells. Plasma levels of PlGF were higher in patients with PDAC compared to controls. CONCLUSION: Circulating ELCs are a potential biomarker of PDAC neovascularization, and PlGF may be an important target in treatment of PDAC.
Assuntos
Carcinoma Ductal Pancreático/sangue , Carcinoma Ductal Pancreático/irrigação sanguínea , Células Endoteliais/patologia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/cirurgia , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/sangue , Neovascularização Patológica/patologia , Neoplasias Pancreáticas/cirurgia , Fator de Crescimento Placentário , Proteínas da Gravidez/sangue , Proteínas da Gravidez/metabolismo , Fator A de Crescimento do Endotélio Vascular/sangue , Fator A de Crescimento do Endotélio Vascular/metabolismoRESUMO
BACKGROUND: This experimental study was designed to determine if Helicobacter spp. contribute to benign gallbladder disease using polymerase chain reaction (PCR) methods. METHODS: Patients with benign gallbladder disease scheduled for elective cholecystectomy at New York University Langone Medical Center were recruited from February to May 2008. Bile, gallbladder tissue and gallstones were collected. DNA was isolated from these specimens and amplified via PCR using C97F and C98R primers specific for Helicobacter spp. Appropriate positive and negative controls were used. Products were analysed with agarose gel electrophoresis, sequenced and results aligned using sequencher. Plasma was collected for detection of anti-Helicobacter pylori antibodies via enzyme-linked immunosorbent assay. RESULTS: Of 36 patients, 12 patients' bile and/or tissue were positive for Helicobacter spp. by PCR. Species were most homologous with H. pylori, although other Helicobacter spp. were suggested. Six of 12 patients demonstrated anti-Helicobacter antibodies in plasma, suggesting that the remaining six might have demonstrated other species besides H. pylori. Four of six plasma samples with anti-Helicobacter antibodies were anti-CagA (cytotoxin associated gene) negative. DISCUSSION: Helicobacter spp. can be detected in bile and gallbladder tissue of patients with benign gallbladder disease. The contribution of these bacteria to the pathophysiology of gallbladder disease and gallstone formation requires further study.
Assuntos
Bile/microbiologia , Vesícula Biliar/microbiologia , Cálculos Biliares/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Helicobacter/isolamento & purificação , Adulto , Idoso , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/imunologia , Proteínas de Bactérias/imunologia , Colecistectomia , DNA Bacteriano/isolamento & purificação , Procedimentos Cirúrgicos Eletivos , Eletroforese em Gel de Ágar , Ensaio de Imunoadsorção Enzimática , Feminino , Vesícula Biliar/cirurgia , Cálculos Biliares/cirurgia , Helicobacter/genética , Helicobacter/imunologia , Infecções por Helicobacter/cirurgia , Helicobacter pylori/genética , Helicobacter pylori/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Reação em Cadeia da Polimerase , Adulto JovemRESUMO
INTRODUCTION: This study was designed to compare symptomatic outcomes following cholecystectomy in patients with biliary dyskinesia. MATERIALS AND METHODS: From 1999 to 2006 at New York University Medical Center, 197 adults underwent hepatobiliary scintigraphy with cholecystokinin administration to evaluate gallbladder ejection fraction (GBEF). Biliary dyskinesia was demonstrated in 120 patients based on decreased GBEF of =35%. Forty-four patients underwent cholecystectomy, and data from chart review and telephone questionnaires were available for 42 patients. Patients reported symptomatic improvement whether gallstones were present (25/27, 92.6%) or absent (13/15, 86.7%) prior to cholecystectomy (p = 0.90). The most common pathologic findings were chronic cholecystitis and cholesterolosis, regardless of the presence of gallstones. Additional data from 101 of the 120 patients with decreased GBEF demonstrated 74/101 (73.2%) patients were diagnosed with gastroesophageal reflux disease (GERD), and 59/101 (58.4%) patients were diagnosed with gastritis. RESULTS: The results of this study suggest that biliary dyskinesia should be considered as part of the spectrum of symptomatic gallbladder disease that can be successfully treated with cholecystectomy and that biliary dyskinesia is associated with GERD and gastritis.
Assuntos
Discinesia Biliar/cirurgia , Colecistectomia/métodos , Esvaziamento da Vesícula Biliar/fisiologia , Vesícula Biliar/fisiopatologia , Adulto , Discinesia Biliar/diagnóstico , Discinesia Biliar/fisiopatologia , Colangiopancreatografia por Ressonância Magnética , Feminino , Seguimentos , Vesícula Biliar/cirurgia , Humanos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Calcified catheter "cast" found on radiologic studies after central venous catheter removal is a rare complication that has been reported twice. Both cases were associated with thrombus. In this case report, we present a 15-year-old boy with acute lymphoblastic leukemia who demonstrated on CT scan a radiopacity in his left brachiocephalic vein after removal of an implanted venous access device. This was initially thought to be a retained catheter fragment. Diagnostic studies, including venogram, excluded the presence of a retained catheter fragment. Additional procedures to retrieve a nonexistent catheter fragment were thus avoided. Therefore, a catheter "cast" should be considered as part of the differential diagnosis when calcification is found on an imaging study after removal of an implantable venous access device to prevent an unwarranted surgical exploration.
Assuntos
Calcinose/diagnóstico , Cateterismo Venoso Central/efeitos adversos , Remoção de Dispositivo/efeitos adversos , Migração de Corpo Estranho/diagnóstico , Adolescente , Veias Braquiocefálicas/diagnóstico por imagem , Calcinose/etiologia , Cateteres de Demora/efeitos adversos , Diagnóstico Diferencial , Humanos , Masculino , Flebografia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Tomografia Computadorizada por Raios XRESUMO
Sarcoidosis involving the pancreas is a rare occurrence. Isolated cases of localized or diffuse involvement of the pancreas have been reported in the literature. The preoperative diagnosis of this entity is a clinical challenge, and surgical intervention is usually needed to make a definitive diagnosis. We report a patient that presents with a preoperative evaluation suggestive of cholangiocarcinoma. Surgical management involved pancreaticoduodenectomy, which revealed pancreatic sarcoidosis with regional lymph node involvement. An extensive literature review of sarcoidosis of the pancreas is provided, which cites all reported cases in which the presentation warranted surgical intervention.
Assuntos
Pancreatopatias/diagnóstico , Sarcoidose/diagnóstico , Ampola Hepatopancreática , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Pancreatopatias/patologia , Neoplasias Pancreáticas/diagnóstico , Sarcoidose/patologia , Tomografia Computadorizada por Raios XRESUMO
It is unclear why immunological control of HIV replication is incomplete in most infected individuals. We examined here the CD8+ T cell response to HIV-infected CD4+ T cells in rare patients with immunological control of HIV. Although high frequencies of HIV-specific CD8+ T cells were present in nonprogressors and progressors, only those of nonprogressors maintained a high proliferative capacity. This proliferation was coupled to increases in perforin expression. These results indicated that nonprogressors were differentiated by increased proliferative capacity of HIV-specific CD8+ T cells linked to enhanced effector function. In addition, the relative absence of these functions in progressors may represent a mechanism by which HIV avoids immunological control.