Colonoscopy: Preparation and Potential Complications.

Colonoscopy is a fairly common test that serves both diagnostic and therapeutic purposes. It has been considered the gold standard in colorectal cancer screening for several years. Due to the nature of the examination, various types of complications may occur. The purpose of this analysis is to describe the various complications related to the period of preparation for colonoscopy among hospitalized patients, including life-threatening ones, in order to know how to avoid complications while preparing for a colonoscopy. We analyzed the nursing and medical reports of 9962 patients who were prepared for colonoscopy between 2005 and 2016. The frequency of various side effects associated with intensive bowel cleansing prior to colonoscopy was assessed. In justified cases, additional medical data were collected from patients, their families or from other doctors providing advice to patients after complications. Out of 9962 patients prepared for colonoscopy, 180 procedures were discontinued due to complications and side effects, and in these cases no colonoscopy was performed. The most common complications were: vomiting; epistaxis; loss of consciousness with head injury; abdominal pain; acute diarrhea; symptoms of choking; heart rhythm disturbances; dyspnea; fractures of limbs and hands; acute coronary syndrome; hypotension; hypertension; cerebral ischemia; severe blood glucose fluctuations; increased muscle contraction and allergic reactions. In addition to the documentation of our own research, several works of other research groups were also analyzed. Currently, the literature does not provide data on the frequency and type of complications in the preparation period for colonoscopy. The advantage of our work is the awareness of the possibility of serious complications and postulating the necessary identification of threats. Individualization of the recommended procedures and increased supervision of patients undergoing bowel cleansing procedure, we hope, will reduce the occurrence of complications and side effects.

The role of photodynamic therapy in breast cancer - A review of in vitro research.

Breast cancer is the most common cancer affecting women and the incidence of occurrence is increasing. Currently, there are many methods of detecting and treating breast cancer. Some treatments have a number of side effects. Photodynamic therapy (PDT) is a minimally invasive method of treatment which uses monochromatic light of low to medium energy to excite previously applied photosensitizers (PS) for ROS production. The purpose of this article is to present a general overview of the use of PDT in in vitro studies of various cancer cell lines. A literature search for articles corresponding to the topic of this review was performed using the PubMed and Scopus databases using the following keywords: 'photodynamic therapy', 'breast cancer', and 'photosensitizer(s).' Much of the reviewed literature is based on evaluations of the cytotoxic potential of various PSs, particularly against the MCF-7 cell line, and enhancement of PDT potential with nanotechnology. Research on photodynamic effects in vitro may be helpful in the pre-clinical search for optimal methods for in vivo clinical treatment.

The Use of Upconversion Nanoparticles in Prostate Cancer Photodynamic Therapy.

Photodynamic Therapy (PDT) is a cancer treatment that uses light, a photosensitizer, and oxygen to destroy tumors. This article is a review of approaches to the treatment of prostate cancer applying upconversion nanoparticles (UCNPs). UCNPs have become a phenomenon that are rapidly gaining recognition in medicine. They have proven to be highly selective and specific and present a powerful tool in the diagnosis and treatment of prostate cancer. Prostate cancer is a huge health problem in Western countries. Its early detection can significantly improve patients' prognosis, but currently used diagnostic methods leave much to be desired. Recently developed methodologies regarding UCNP research between the years 2021 and 2014 for prostate cancer PDT will also be discussed. Current limitations in PDT include tissue irradiation with visible wavelengths that have a short tissue penetration depth. PDT with the objectives to synthesize UCNPs composed of a lanthanide core with a coating of adsorbed dye that will generate fluorescence after excitation with near-infrared light to illuminate deep tissue is a subject of intense research in prostate cancer.

The role of autofluorescence, photodynamic diagnosis and Photodynamic therapy in malignant tumors of the duodenum.

This article presents the current state of knowledge and a review of the literature in terms of the prevalence, etiopathogenesis, differential diagnosis, management, prognosis, and treatment of malignant tumors of the duodenum. The role of autofluorescence and photodynamic diagnosis as an emerging treatment method for rarely o ccurring duodenal malignant neoplasms .. We selected publications which can be found in databases such as The National Center for Biotechnology Information, U.S. National Library of Medicine (PubMed), The American Chemical Society, The American Association of Pharmaceutical Sciences and The American Society for Photobiology and The Canada Institute for Scientific and Technical Information.

Clinical Trials and Basic Research in Photodynamic Diagnostics and Therapies from the Center for Laser Diagnostics and Therapy in Poland.

The purpose of this review is to present an overview of the development of photodiagnostic and photodynamic therapy (PDD and PDT) techniques in Poland. The paper discusses the principles of PDD, including fluorescent techniques in determining precancerous conditions and cancers of the skin, digestive tract, bladder and respiratory tract. Methods of PDT of cancer will be discussed and the current state of knowledge as well as future trends in the development of photodynamic techniques will be presented, including the possibility of using photodynamic antimicrobial therapy. Research pioneers in photodynamic medicine such as Thomas Dougherty are an inspiration for the development of methods of PDD and PDT in our Clinic. The Center for Laser Diagnostics and Therapy in Bytom, Poland, promotes the propagation of PDD and PDT through the training of clinicians and raising awareness among students in training and the general public. Physicians at the Center are engaged in photomedical research aimed at clinical implementation and exploration of new avenues in photomedicine while optimizing existing modalities. The Center promotes dissemination of clinical results from a wide range of topics in PDD and PDT and serving as representative authorities of photodynamic medicine in Poland and Europe.

Stratification of the dysplasia and neoplasia risk using autofluorescence endoscopic surveillance of Barrett's esophagus.

BACKGROUND: This study assessed the efficacy of autofluorescence endoscopy (AFE) using the Onco-LIFE system and numerical color value (NCV) estimation in comparison to white light endoscopy (WLE) in endoscopic surveillance for identification of early dysplasia in Barrett's esophagus (BE) to aid in real-time image elucidation and minimize the overreliance on biopsy and histology. METHODS: AFE, performed simultaneously during WLE, with biopsy was performed among 24 patients with BE. None of these patients had any obvious mucosal abnormalities in WLE. A total of 376 biopsies were taken, include 325 randomly collected according to Seattle Protocol and 51 additional biopsies, taken from the sites with pathological AF and NCV. All biopsy sites were assessed in vivo using WLE, AFE and NCV and compared to histological examinations, to estimate the efficacy of these methods in dysplasia assessment in BE. RESULTS: In the case of 248 biopsies taken from sites with NCV below 1.0, two cases of unspecified dysplasia were recognized; in 14 biopsies with NCV above 2.0 in all cases the various grades of dysplasia were documented. Dysplasia was found in 42% of AFE + NCV- guided biopsy specimens, and in 7.1% of WLE-guided biopsy specimens. AFE + NCV detected high-grade dysplasia in 7 patients, 6 more than according to Seattle Protocol in WLE. The expected odds of dysplasia detection in a sample increases almost 1.9 times, if it was selected by the AFE method (p < 0.001), when compared to WLE and with accordance with Seattle Protocol guided biopsy. CONCLUSION: The above results indicate that AFE + NCV using the Onco-LIFE system leads to improved BE lesion visualization for targeted biopsy with accurate histologic correlation compared to WLE and Seattle Protocol guided biopsy alone, and can serve to minimize additional biopsies.

Benign and non-neoplastic tumours of the duodenum.

This review study describes the problem of duodenal tumours, which are rare but important in gastrological practice. The most common location of small intestinal tumours is the duodenum, and this observation is probably partly due to the greater diagnostic availability for most proximal segments of the small intestine. Among tumours the following should be mentioned - benign: adenomas, lipomas, haemangiomas, and leiomyomas; and malignant: malignant tumours of epithelial origin, primary gastrointestinal stromal tumours, neuroendocrine tumours and carcinoids, lymphomas, sarcomas, teratomas, and secondary metastases. Early duodenal tumour recognition, especially with histological assessment, plays a crucial diagnostic role with future therapeutic implications. In recent years the prevalence of benign duodenal tumours has been rising due to a higher level of clinicians' doubts and the convenience of gastrointestinal endoscopy; hence, knowledge of this problem is important in routine clinical practice. The method of duodenal tumour treatment should be selected on an individual basis.

The influence of 5-aminolevulinic photodynamic therapy on colon cancer cell interleukin secretion in hypoxia-like condition in vitro.

Photodynamic therapy (PDT) becomes a method of personalized cancer treatment, based on the individual determination of cancer biomarkers. The aim of the study was to evaluate the influence of PDT with δ-aminolevulinic acid (ALA-PDT) used in sub-lethal dose on the interleukins secretion (IL-6, IL-8 and IL-10) by the residual colon cancer cells (CCC) under hypoxia-like conditions (addition of cobalt chloride- CoCl2). CCC: SW480 and SW620 cells were incubated with ALA, CoCl2 and irradiated with red light. The cells viability was detected using MTT assay, LDH and apoptosis tests. Determination of interleukins was carried out using the Bio- Plex Assay Pro™ kit on the Bio- Plex Suspension Array System. After ALA-PDT we found no change in the IL-6 level secreted by SW480 cells, but decrease of IL-6, IL-10 secretion by SW620 cells, an increase in the IL-8 secreted by both cells lines. The levels of IL-6, IL-8 and IL-10 secreted by more aggressive SW620 cells were higher than released by SW480 cells. We concluded, that PDT not only effectively destroy malignant tissue, but also used in sub-lethal dose can develops its anticancer activity through the reduction of IL-6 and IL-10 secretion. On the other hand, we reveal an unfavorable PDT effect, connected with increase of IL-8 secretion by both treated colon cancer cell lines, which implicates the use of adjuvant immunotherapy against IL-8, as a part of individualized colon cancer therapy.

Does the Numerical Colour Value (NCV) correlate with preneoplastic and neoplastic colorectal lesions?

BACKGROUND: White light endoscopy (WLE) is the gold standard for detection of colorectal cancer. Autofluorescence endoscopy (AFE) is among the novel methods expected to increase the sensitivity and specificity of endoscopic diagnosis. The main objective of the study was to determine the diagnostic efficacy of AFE for the detection of preneoplastic and neoplastic colorectal lesions and to identify high-grade neoplasia using Numerical Colour Value (NCV). METHODS: This retrospective study included 188 patients with colorectal mucosal lesions diagnosed on WLE and assessed using AFE; they were included in the study if a complete patient record was available (description of visualized colorectal lesions, NCV and histopathology report). The NCV was compared with the histological result. RESULTS: Histology revealed 38 hyperplastic colon polyps, 77 low-grade dysplastic lesions, 17 high-grade dysplastic lesions, 24 adenocarcinomas and 32 inflammatory lesions. The mean NCVs of high-grade dysplasia (HGD) and adenocarcinoma were 2.24 ±â€¯0.22 and 2.73 ±â€¯0.16, respectively, significantly higher than the NCV of hyperplastic colon polyps (0.95 ±â€¯0.06), low-grade dysplasia (LGD) (1.27 ±â€¯0.05) and inflammatory lesions (1.26 ±â€¯0.17). The NCV cut-off value for HGD and adenocarcinoma was set at 1.7. The sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) were 95.2%, 87.9%, 97.5%, 84.8%, respectively. CONCLUSION: Our study showed that AFE could provide useful diagnostic information regarding preneoplastic and neoplastic colorectal lesions. Additionally, the NCV significantly correlated with the histopathology results.

The benefits of targeted endoscopic biopsy performed using the autofluorescence based diagnostic technique in 67 cases of diagnostically difficult gastrointestinal tumors.

INTRODUCTION: The search for new diagnostic and therapeutic procedures is an essential task in contemporary oncology. The purpose of our study was the evaluation of the practical usefulness of autofluorescence endoscopy (AFE) using the Onco-LIFE system, compared with the use of white light endoscopy (WLE), and the estimation of the correlation between the histopathological evaluation with the degree of lesions' Numerical Color Value (NCV index) and the method's sensitivity and specificity valuation. MATERIAL: 67 patients were analyzed at the Center for Laser Diagnostics and Therapy. All patients previously had a gastrointestinal tract tumor, which appeared malignant, but without histopathological confirmation. We measured NCV, estimated the correlation of the clinical diagnosis based on histopathological evaluation with the degree of NCV index from gastrointestinal lesions, and calculated the sensitivity and specificity of this method. RESULTS: In the group of 67 patients, we found 44 cases of primary or secondary cancers and 7 cases of non-epithelial malignancies. In this group (51 patients) we identified 13 colorectal cancers and 38 upper gastrointestinal cancers. Based on the NCV index at NCV > 1.0, we revealed, that the sensitivity for malignant neoplastic lesions was 100% and the specificity was 73%, while for NCV > 1.5, the sensitivity for malignant neoplastic lesions was 86% and the specificity 100%. CONCLUSION: AFE using the Onco-LIFE system is a helpful tool to perform targeted biopsies at the outset. A significant correlation was found between lesions' NCV index and the grade of dysplasia or tumor malignancy. AFE sensitivity and specificity is higher than WLE. Further studies are needed, especially performed by expert endoscopists.

Influence of ALA-mediated photodynamic therapy on secretion of interleukins 6, 8 and 10 by colon cancer cells in vitro.

BACKGROUND: Photodynamic therapy has apart from a direct cytotoxic effect also immunomodulatory properties. The aim of our study was to investigate how photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) in sublethal doses influences the secretion of interleukins 6, 8 and 10 from colon cancer cells in vitro. METHODS: We used two human colon cancer cell lines SW480 and SW620 of different malignancies which were treated with a sublethal PDT protocol. Determination of interleukins was carried out using the Bio- Plex Assay Pro™ kit on the Bio- Plex Suspension Array System. RESULTS: Sublethal ALA-PDT did not affect IL-6 secretion by SW480 cells, but caused a 40% decrease of IL-6 release by the SW620 cell line. It increased IL-8 secretion in both, the SW480 and SW620 cell lines, by 23% and 46%, respectively, and decreased the production of IL-10 (25% in SW480 and 32% in SW620 cells). CONCLUSIONS: ALA-PDT in sublethal doses might influence colon cancer cell's progression and invasion by reducing the secretion of IL-6, IL-10 and increasing the IL-8 concentration with higher values in the more malignant cell line.

Secretion of the angiogenic factor VEGF after photodynamic therapy with ALA under hypoxia-like conditions in colon cancer cells.

BACKGROUND: Photodynamic therapy (PDT), eliminates not only the tumor, but also modulates signaling factors release, e.g. vascular endothelial growth factor (VEGF), which plays a crucial role in cancer progression. Assessment of the VEGF-secreting activity of resistant colon cancer cells in different degree of malignancy: SW480 and SW620 under hypoxia-like conditions during δ- aminolevulinic acid (ALA) PDT was the objective of our study. METHODS: The colon cancer cell lines SW480 and SW620 were treated in sublethal doses with ALA PDT in hypoxia- like conditions with cobalt chloride (CoCl2). To assess cell viability, MTT assays were performed and the discrimination of the cell death mode was monitored via fluorescence microscopy. The cells cytotoxicity using LDH test was assessed. Determination of VEGF was carried out using the Bio- Plex Assay Pro™ kit on the Bio- Plex Suspension Array System. RESULTS: ALA PDT used in sublethal doses decreases release of VEGF in more aggressively growing SW620 colon cancer cell line in hypoxia-like conditions. In addition the level of secretion of VEGF in SW620 was much higher than in SW480 cells, which correlates with the grade of aggressive growth of colon cancer cells. CONCLUSION: Our outcomes offer evidence, that in hypoxia mimic condition sublethal ALA-PDT- mediated VEGF inhibition could be clinically relevant.

[Constipation - natural methods of the treatment with regard to physiotherapeutic procedures].

The constipations belong to the most frequent intestinal dyspepsia ailments in the industrialized populations. Alimentary canal answers for the correct admission and digesting foods, their absorption and dismissing. In case of disorders relating dismissing the names a constipation, discomfort in everyday life constrain ill's to modification style of life and nourishing, as well as the frequent contact with a doctor or the specialist medical care. The etiology of constipations stool is multifactorial, what requires multidirectional therapeutic conduction. The name of constipation is dismissing of stool defines (seldom than 3 days), be unusually the made difficult of act defecation connected with the presence sale hard and compact stool. Not infrequently the dismissing of incomplete evacuation lace-up by ill with feeling of dysfunction. The constipations most often step out in relationship with excessive contractibility of intestine - spastic constipations, be with reason of excessive atony of intestine - atonic constipations where sale weak peristalsis is the creature of constipations. In this work was the selected non - pharmacological methods in the treatment of constipation with regard a physiotherapeutic conduct introduced.

ALA-induced photodynamic effect on viability, apoptosis and secretion of S100 protein, secreted by colon cancer cells in vitro.

BACKGROUND: S100 protein is a proven prognostic factor in cancers. In colorectal cancers, its secretion correlates with clinical stage of the disease. Photodynamic therapy (PDT) is used as a supporting therapy in treatment of this particular cancer. The main aim of our study was to estimate the effect of photodynamic therapy with 5-aminolevulinic acid (ALA) in sublethal doses (ALA-PDT) on the secretion of S100 protein by colon cancer cells. METHODS: Investigations were performed on two colon cancer cell lines. The SW480 cell line is a culture containing locally malignant cancer. The SW620 line is characterized by high metastatic activity. Each line was exposed to different concentrations of photosensitizer's precursor-ALA, and various level of light radiation. Afterwards, cell viability, using MTT and LDH assays and apoptosis of both lines was assessed. Then measurement of S100 protein concentration was performed using a 2-step enzyme immunoassay. RESULTS: After application of ALA PDT the S100 protein concentration was reduced by 27% in SW480 cell line and by 30% in SW620 cell line. At the same time there has been no increase in the concentration of S100 protein in cells exposed to the light alone. It was demonstrated that the more aggressive line SW620 releases higher levels of S100 proteins in comparison with the line SW480. CONCLUSION: The outcome of this study presented beneficial effect of ALA-PDT on persistent colon cancer cells. This therapy leads to decrease of S100 protein concentration in both colon cancer cell lines: SW480 and SW620.

Photodynamic therapy in colorectal cancer treatment--The state of the art in preclinical research.

BACKGROUND: Photodynamic therapy (PDT) is used in many different oncologic fields. Also in gastroenterology, where have been a few attempts to treat both the premalignant lesion and advanced colorectal cancer (CRC). This review aims to give a general overview of preclinical photodynamic studies related to CRC cells and animal studies of photodynamic effects related to CRC treatment to emphasize their potential in study of PDT mechanism, safety and efficiency to translate these results into clinical benefit in CRC treatment. MATERIALS AND METHOD: Literature on in vitro preclinical photodynamic studies related to CRC cells and animal studies of photodynamic effects related to CRC treatment with the fallowing medical subject headings search terms: colorectal cancer, photodynamic therapy, photosensitizer(s), in vitro, cell culture(s), in vivo, animal experiment(s). The articles were selected by their relevance to the topic. RESULTS: The majority of preclinical studies concerning possibility of PDT application in colon and rectal cancer is focused on phototoxic action of photosensitizers toward cultured colorectal tumor cells in vitro. The purposes of animal experiments are usually elucidation of mechanisms of observed photodynamic effects in scale of organism, estimation of PDT safety and efficiency and translation of these results into clinical benefit. CONCLUDING REMARKS: In vitro photodynamic studies and animal experiments can be useful for studies of mechanisms and efficiency of photodynamic method as a start point on PDT clinical research. The primary disadvantage of in vitro experiments is a risk of over-interpretation of their results during extrapolation to the entire CRC.

Photodynamic therapy in colorectal cancer treatment: the state of the art in clinical trials.

BACKGROUND: Photodynamic therapy (PDT) is used in many different oncologic fields. Also in gastroenterology, where have been a few attempts to treat both the premalignant lesion and advanced colorectal cancer. This review aims to give a general overview of the PDT application to colorectal cancer in the field of clinical trials to emphasize its curative, and insufficiently exploited potential. MATERIALS AND METHODS: Literature on PDT for colorectal cancer with the following medical subject headings search terms: colorectal cancer, photodynamic therapy, clinical trials was reviewed. The articles were selected by their relevance to the topic. RESULTS: There are many positive and promising trial results from I to II/III phase for the use of PDT in colorectal cancer both in less advanced tumors as well as in the palliative therapy of advanced lesions. CONCLUDING REMARKS: PDT seems to be a safe and a feasible treatment option for colorectal cancer. Theoretical assumptions confirmed by many results of preclinical studies taking into consideration an increasing number of analyzed clinical trials, should lead to the development of optimized standards by using PDT in colorectal cancer treatment.

ALA-mediated photodynamic effect on apoptosis induction and secretion of macrophage migration inhibitory factor (MIF) and of monocyte chemotactic protein (MCP-1) by colon cancer cells in normoxia and in hypoxia-like conditions in vitro.

BACKGROUND: Photodynamic therapy (PDT) reveals immune modulatory effect. The aim of the study was to evaluate the influence of 5-aminolevulinic acid (ALA) mediated photodynamic effect on secretory activity (MIF, MCP-1) of colon cancer cells in vitro both in normoxia and in hypoxia-like conditions. METHODS: Two colon cancer cell lines differing in malignancy potential: SW480 (lower grade) and SW620 (higher grade) were used. MCP-1 and MIF concentrations in supernatants of cells cultures after pretreatment with ALA at concentrations of 500, 1000 and 1500µM and irradiation with incoherent light (λ=600-720nm) at fluences of 10, 30 and 60J/cm(2), using Bio-Plex ProTM Assay kit and Bio-Plex Suspension Array System apparatus, were measured. RESULTS: The SW620 cells were more susceptible to ALA-mediated phototoxic effect than SW480 one, however this effect may be partly abolished in hypoxia-like condition. In the case of SW480 cell line, no influence of hypoxia-like conditions on cell susceptibility to ALA-mediated photodynamic effect was found. The MIF concentration increased, contrary to MCP-1 one which decreased after ALA-mediated photodynamic action in both cell lines. No difference between cytokines concentration in supernatant from cells cultures in normoxia or hypoxia-like conditions was observed. CONCLUSIONS: Detected reduction in MCP-1 secretion appears to be advantage because of tumor's growth limiting but an increase in the secretion of MIF, which is responsible for stimulation of tumor cells proliferation, is an unfavorable effect. These results may be explained by the fact that the used cancer cell lines differ from each other in cancer stage.

Photodynamic therapy in treatment of cutaneous and choroidal melanoma.

Melanoma is a malignant, the most aggressive and dreaded skin cancer. This form of cancer arises from melanocytes and may grow rapidly and metastasize. Melanoma predominantly occurs in skin, but could also be found in the mouth, iris and retina of the eye. Melanoma is the most dangerous form of skin cancer, with a steeply rising incidence and a poor prognosis in its advanced stages. It is highly resistant to traditional chemotherapy and radiotherapy, although modern biological therapies are showing some promise. Photodynamic therapy (PDT), as a novel effective modality of the treatment of skin cancers, opens up new possibilities in melanoma treatment also. Many experimental photodynamic therapy studies were performed. The results of many experiments indicate that that photodynamic therapy may be a promising tool for adjuvant treatment in advanced melanoma.

The role of fluorescence diagnosis in clinical practice.

Fluorescence diagnosis is a fast, easy, noninvasive, selective, and sensitive diagnostic tool for estimation of treatment results in oncology. In clinical practice the use of photodynamic diagnosis is focused on five targets: detection for prevention of malignant transformation precancerous changes, detection of neoplasmatic tissue in the early stages for fast removal, prevention of expansion and detection of recurrence of the cancer, monitoring therapy, and the possibility of excluding neoplasmatic disease. In this article, selected applications of fluorescence diagnosis at the Center for Laser Diagnostics and Therapy in Bytom, Poland, for each of these targets are presented.

Surgical treatment of a rare case of granular cell tumour of the cervical oesophagus.

A female patient was operated upon due to cervical oesophageal stricture induced by a tumour located just below the throat. Local excision of the tumour and reconstruction of the oesophageal wall was performed using the pre-vertebral fascia due to the presence of extensive oesophageal mucosa damage. The patient also required temporary alimentation by the gastrostomy route due to swallowing disturbances. The oesophagram depicted a contrasting airway passage without any evidence of fistula and contrast medium leakage through the oesophageal lumen. Four months after the operation, the patient did not report any issue with oral intake. The postoperative histopathological and immunohistochemical examinations provided evidence of a granular cell tumour (GCT). We believe that local excision of the tumour should always be considered in cases of tumours located close to the throat because it is less invasive than partial resection of a GCT in the oesophagus or oesophagogastrectomy.