Cerebral Digital Subtraction Angiography in Acute Intracranial Hemorrhage: Considerations in Critically Ill Children

Cerebrovascular disorders are an important cause of morbidity and mortality in children. Although minimally invasive, cerebral digital subtraction angiography (DSA) has been shown to be safe in children and is a valuable, and perhaps underutilized, technique for the diagnosis and management of pediatric cerebrovascular disorders in the critical care setting. Through a case-based approach, we explore the utility of DSA in critically ill children with acute intracranial hemorrhage (ICH). We discuss the use of DSA in the acute management of aneurysm and arteriovenous malformation rupture as well as cerebral vasospasm. Those caring for critically ill children with acute ICH should consider cerebral DSA as part of a comprehensive approach to the diagnosis and management of these conditions.

A Pediatrician's Guide to Working with Children on the Autism Spectrum in Coronavirus Disease 2019 and Beyond: Retrospect and Prospect

The COVID-19 pandemic is an unprecedented event with devastating effects on children and families, highlighting and broadening disparities in the care of children with developmental disabilities, while simultaneously catalyzing innovation. Children are vulnerable to the impacts of COVID-19, resulting in increased stress, anxiety, isolation, and health challenges, further amplified in autistic children and children with other neurodevelopmental disabilities. These children are uniquely vulnerable due to communication impairments, comorbid medical disorders, reduced adaptability, and reliance on therapeutic interventions. Abrupt reduction in services and access to care during the pandemic compromised physical and mental health and led to missed intervention opportunities at critical times. It is important to examine the effects that the pandemic triggered, address deficiencies, and recognize new opportunities to improve systems of care to prepare for unforeseen futures.

Navigating Medical Care for a Young Adult with Developmental Disability

CASE

Sam is a 20-year-old young man with intermittent gastritis, autism spectrum disorder, and intellectual disability who was admitted to the hospital because of nutritional concerns. His parents have legal guardianship and report that he has had increasing frequency of refusal to eat, resulting in a 15-pound weight loss over the past 3 months. On admission, a multidisciplinary team including specialists in gastroenterology, nutrition, feeding (behavioral and mechanical), psychiatry, palliative care, and social work was engaged to develop an evaluation and care plan. Sam's nutritional assessment was significant for severe malnutrition. An upper endoscopy was performed and was without abnormalities, including signs of significant gastritis.An upper endoscopy was performed and was without abnormalities, including signs of significant gastritis.A carefully obtained history found that Sam does not have a primary care physician. He was recently hospitalized at another facility because of his weight loss and nutritional concerns but was discharged against medical advice because of parental dissatisfaction with his care. His mother shared that she has tried many strategies to encourage Sam to eat including pushing spoons of food into his mouth, syringe feeding, and verbally pleading with Sam to take a bite, but all of these have been without success.Because of concerns that persistent attempts to verbally and physically coerce Sam to eat may be contributing to his aversion to food/eating, the feeding team provided Sam's parents with education and coaching for utilization of behavioral cues to determine when Sam wanted to eat. Despite parents expressing their understanding of the importance of avoiding physical attempts to "make" Sam eat and the team palliative care physician meeting with Sam's parents to elicit their goals for Sam's care, his nurses reported observing several instances of Sam's mother tapping a loaded spoon on his lips. Because of minimal oral intake, a nasogastric tube was placed for provision of hydration and nutrition. Sam's parents consented to the use of soft restraints and the presence of a bedside patient care assistant because of Sam becoming agitated and pulling at the tube.After 10 days of hospitalization, Sam was taking about 50% of his goal intake by mouth. Unfortunately, Sam removed his NG tube, and his parents refused to allow the tube to be replaced. Sam's parents then discharged him against medical advice, stating that they believed he would recover better at home. What are important considerations in caring for patients like Sam in the hospital setting and beyond?

The Sentinel Node in Anal Carcinoma

Aims and Background

Anal cancer is a rare condition. The inguinal lymph nodes are the most common site of metastasis in this neoplasm. The inguinal lymph node status is an important prognostic indicator and the presence of metastases is an independent prognostic factor for local failure and overall mortality. Depending on the primary tumor size and histological differentiation, metastasis to superficial inguinal lymph nodes occurs in 15-25% of cases.

Methods and Study Design

To evaluate the inguinal lymph node status we performed a search for the sentinel node in a female patient affected by squamous anal carcinoma.

Results

Identification and examination of the sentinel node was positive and postoperative histology showed the presence of bilateral lymph node metastases.

Conclusions

We suggest that examination of the sentinel node in anal cancer could be an efficient way to establish the inguinal lymph node status, which would help the clinician to plan and perform adequate treatment.

Negative predictive value of endoscopic ultrasound in patients referred for fine-needle aspiration

AIM

Endoscopic ultrasound (EUS) is a valuable diagnostic tool in pancreatic diseases and its high negative predictive value (NPV) in excluding malignancies is universally recognized. Moreover, EUS with fine-needle aspiration (EUS-FNA) can significantly impact on diagnosis and management of many clinical conditions. However, there are circumstances in which EUS-FNA cannot or should not be performed. We evaluated the factors that prevented us from performing or induced us not to perform FNA.

METHODS

The study was conducted in a tertiary university hospital. A total of 211 patients suspected of having solid pancreatic malignancy on the basis of clinical presentation and computed tomography and/or magnetic resonance imaging was included. When FNA was withheld because not deemed necessary by the operator, the NPV of EUS was calculated.

RESULTS

In 9 patients (4.3% of the procedures), FNA was withheld because of contraindications that should have been foreseen by the referring physician. In 30 subjects, FNA was not accomplished as no lesions requiring biopsy were actually found at EUS exploration. In this group, EUS reached a NPV of 96.7% in excluding malignancy, but it reached 100% in patients without chronic pancreatitis.

CONCLUSION

In a cohort of patients with high pre-test probability of malignancy, the high NPV of EUS was confirmed. False negative results should be expected in patients with chronic pancreatitis and they need a strict follow-up.

Endoscopic ultrasonography in hepatology: focus on portal hypertension

Portal hypertension (PHT) is more frequently caused by cirrhosis. Increase in portal pressure induces development of collateral circulation with shunting resulting in disturbances such as gastroesophageal varices (GEV). Prevention and therapy of bleeding from GEV are mandatory. Therefore, the diagnosis of PHT represents a crucial step. Endoscopic ultrasound (EUS), with its combination of endoscopic imaging and ultrasonic capabilities, can offer an almost comprehensive evaluation of portal venous system and porto-systemic collateral circulation. The improved endoscopic view of several video-echoendoscopes has filled the gap between EUS and standard video-endoscopy in diagnosing GEV and in assessing endoscopic criteria of bleeding risk. EUS combined with Color-Doppler capabilities are able to provide hemodynamic information. Furthermore, EUS data allow to stratify patients on the basis of PHT severity and first bleeding risk, monitor the results of pharmacologic and/or endoscopic therapy, predict the response to treatment, quantify the risk of variceal recurrence and recurrent bleeding after GEV obliteration and guide or assist EGD therapy. Despite having this amount of information, there is lack of scientific evidence that EUS imaging and EUS-assisted therapy can have a clear-cut clinical impact and affect patients outcome.

Instruments and accessories for diagnostic endoscopic ultrasound (radial scanning and miniprobes)

Endoscopic ultrasound (EUS) is a relatively new technology developed in the early 80's, but introduced into the clinical practice only in the late 80's. Nowadays there is an increase in demand for EUS examinations and services, because this technique is more and more recognized as an important and integral part in the diagnostic and staging algorithm of many gastrointestinal (GI) and nongastrointestinal pathologies. Even if today the EUS panorama enrich itself with a large number of different instruments, mechanical and electronic scopes, radial and linear ones, several types of miniprobes and specialty probes, for diagnostic purposes the dedicated radial scanning instruments remain the more adopted choice while miniprobes can have applications only in niche areas, like superficial GI cancers staging, small subepithelial lesions evaluation or intraductal ultrasound and some technological advances are needed to solve the potential drawbacks of this miniaturized probes. At last the EUS equipment borrowed most of the electronic sophistication from the mainstream ultrasonography, this made the choice of an EUS instrument even more difficult and challenging, but you must consider that there is no right or wrong equipment, there is only the right instrument for that specific clinical need or situation.

Role of endoscopic ultrasound in biliary and unexplained pancreatitis

In the Western world, gallstone disease accounts for approximately half of the cases of acute pancreatitis. The benefit of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) has been clearly proven for this disease. On the basis of history, laboratory, and noninvasive imaging studies, about 10-30% of patients with acute pancreatitis have no apparent aetiology. This is critical because it limits the optimal therapeutic management and the prevention of recurrence. Endoscopic ultrasound (EUS) has emerged as an important procedure to clarify the aetiology of acute pancreatitis. After extensive investigation that included EUS, 8-20% of episodes remained idiopathic. Moreover, EUS carried minimal risk when compared to ERCP. The present short review attempts to update on the indications for the employment of EUS in the diagnosis of biliary stones as well as in the clarification of aetiology in the case of unexplained pancreatitis.

[Lymphoscintigraphic localization of sentinel lymph nodes in colorectal carcinoma in early stage: results of a single center study and proposal of a multicenter protocol]

In colorectal cancer the sentinel node dissection may help to identify any unusual mesenteric lymphatic drainage pattern from the primary tumor site (ex/skip metastases); assuming that accurate pathological staging is critical for therapeutic decisions we are conducing a study to evaluate the feasibility of the sentinel node technique in colorectal neoplasms and its overall accuracy in predicting regional lymph nodes metastases for appropriate staging. From February 2001 to September 2004 we included in this study 30 patients with rectal lesions or degenerate colonic polyps not radically excised by endoscopy. Lymphatic mapping was performed with low molecular weight albumin colloid labelled with 500Mci of 99mTc in a 2 ml volume and injected submucosally by an endoscopic route at the four cardinal points around the tumor, the afternoon before the surgical procedure, both in case of colonic or rectal lesions. Scintigraphic images were obtained with a gamma camera fitted with a general purpose collimator. The day of the intervention, a hand held gamma detecting probe (Scintiprobe m100, Pol-Hi-Tech, Italy) was employed to detect the "hot" nodes, in vivo and ex vivo. These lymph nodes were tagged with a stitch in vivo; the specimen was removed by a standard resection and SLN were dissected ex vivo and sent separately for pathological examination. In case of rectal lesions, the sentinel nodes were searched ex vivo into mesorectal fat in case. All lymph nodes, including blue or hot ones, were embedded separately for preparation of paraffin sections and haematoxylin and eosin staining. Sentinel lymph node were submitted to multi-seriate sections in order to look for micrometastases. Using the radioactive tracer, sentinel lymph nodes were successfully identified in 27 out of 30 patients. Concordance between SLNs and nodal status was observed in 23 out of 27 cases (85%); two patients (7.4%) were upstaged, as SLN was the only site of metastases. In another two cases we observed no concordance between negative sentinel node and non sentinel nodes (false negative rate, 7.4%). Starting from this experience we are proposing a multicentric trial concerning the value of sentinel node technique in rectal cancer and in early colorectal cancers detected by screening programs.

[Day Surgery. An opportunity for postgraduate surgeons' training]

BACKGROUND

It is widely acknowledged that day surgical procedures must be performed by expert personnel or carried out under their supervision. Recent regulations introduced by Schools of Postgraduate Surgery oblige postgraduate surgeons to carry out a number of minor and medium-sized operations. The characteristics of day surgery make it an appropriate organisational model for complying with the requirements of these directives. Interventional research has shown that adequate training permits education to be coupled with good results.

METHODS

The postgraduate surgeons are trained to perform hernioplasty using Trabucco's method through surgical training based on an initial phase of at least 20 operated patients during which they act as the second surgeon, and a phase of 10 patients during which they are the first surgeon working alongside a tutor with proven experience. Five doctors are completing their training, having acted as first surgeon assisted by a tutor during the period 01/11/1999 - 31/10/00 in 60 hernioplasty operations using Trabucco's method out of a total of 143 carried out in the same period, with an average of 12 operations each. Specific informed consent was obtained from all patients. All operations were performed under local anesthesia.

RESULTS

There was no need to convert to general anesthesia. Complications were comparable to those occurring during surgery performed by experienced colleagues. No recurrences were reported. The mean follow-up was 10 months.

CONCLUSIONS

An evaluation of these data confirms the real possibility of dedicating a number of ambulatory surgical procedures to training postgraduate surgeons. This would not lead to a reduced efficacy of treatment and does not increase the percentage of complications.

Surgical treatment for incisional hernias

BACKGROUND

A great variety of surgical techniques have been proposed to repair large abdominal incisional hernias, but the best results are achieved using synthetic grafts as in the Rives' or Ramirez' procedure.

METHODS

During the period September 1993-May 2001, a total of 145 patients, 54 males and 91 females, mean age 52 (range 16-88) with large incisional hernia were observed. Ninety-two hernias were bigger than 10 cm. The average follow-up was 3 years (1-72 months). All successfully underwent surgery using the following techniques: 19 (13.1%) simple fascial sutures, 68 (46.9%) implants of retromuscolar polypropylene grafts (Rives' or Ramirez' technique), 24 (16.5%) subcutaneous meshes, 17 (11.7%) preperitoneal meshes (14 polypropylene, 2 glycolic acid, 1 Goretex), 4 (2.75%) intraperitoneal implants of polypropylene meshes, 13 (9.05%) intraperitoneal glycolic acid grafts plus retromuscular polypropylene graft.

RESULTS

One patient died in postoperative for heart failure. Morbidity was 8 subcutaneous hemorrhagic suffusions, 10 seromas which were resolved by repeated percutaneous drainage, 4 suppurating wounds that did not require graft removal, 2 little recurrences treated by a new mesh repair under local anaesthesia, 2 sinus for mesh intollerance and 1 fistula requiring a new intervention.

CONCLUSIONS

In this report we discuss the tolerability and reliability of mesh repair, especially in Rives' and Ramirez' technique.

Surgical Approach to Cervical Lymph Node Metastasis in Differentiated Thyroid Cancer

Background

Precautionary locoregional lymph node dissection in thyroid carcinomas for diagnostic and/or staging purposes is useless both in differentiated (papillary and follicular) and undifferentiated forms. It is only indicated in medullary carcinomas because of their frequent spread to regional lymph nodes. The objective of lymphadenectomy is to contain tumor spread; however, the procedure may be associated with intraoperative complications and postoperative sequelae. In order to improve the therapeutic management of patients with thyroid carcinoma, diagnostic scintigraphy with 201Tl or 99mTc-sestamibi is used in the advanced and undifferentiated forms of this tumor.

Methods

We have treated a woman submitted three years previously to total thyroidectomy for papillary carcinoma (pT3) without subsequent radiometabolic treatment. On physical examination we noticed a swelling on the left side of the neck. The lesion was confirmed by ultrasonography, CT scan, and scintigraphic examination with 99mTc-sestamibi 24 hours before planned lymphadenectomy. During the surgical procedure we performed radiodetection to localize metastatic lesions.

Results

Intraoperative radiodetection may help to identify residual disease, which is often difficult to trace in the presence of post-surgical fibrosis. In our patient, histological examination of the removed tissue specimens demonstrated that intraoperative radiolocalization had been highly accurate. The eradication of residual disease was confirmed by scintigraphic follow-up after 12 months.

Discussion and conclusions

Scintigraphy with 99mTc-sestamibi has been proposed as a means to localize metastatic spread and possible residual disease after a supposedly radical thyroidectomy. Surgical eradication of all residual tumor guarantees the best disease control without having to resort to radiometabolic therapy. This approach will reduce the incidence of iatrogenic comorbidity and consequently improve the patients' quality of life.

Limits of aortic stop flow infusion chemotherapy in the treatment of advanced cancer

BACKGROUND

Advanced and relapsed tumors remain a challenging disease with a poor and dismal prognosis. Our choice for inoperable tumors consists in a percutaneous treatment strategy involving intra-arterial chemotherapy and hemofiltration, with previous blood stop-flow, which allows high doses of Cisplatin-cisplatinum, cis-diammine-dichloroplatinum (CDDP) and Mitomycin C (MMC) in the tumor-bearing area with minimal systemic toxicity.

METHODS

We analyse the morbidity and mortality associated with stop-flow in 20 patients with unresectable and/or metastatic thoraco- abdominal tumors, non responders to prior systemic chemotherapy.

RESULTS

In our experience, the rate of major side effects of the procedure was 31% with a mortality of 5%. The side effects were related to the radiological procedure and to the chemotherapic treatment. A 74-year-old patient died for acute kidney toxicity within 15 days after the procedure. The other transient toxicity symptoms recorded were: nausea, vomiting, increasing of creatinine levels, diplopia and appearance of necrotic ulcer associated to chemotherapic drugs. Concerning the complications related to the radiological technique, the main problem was the rupture of the balloon stop-flow catheter in four patients.

CONCLUSIONS

Stop-flow is a new procedure that could develop in the future, thanks to the possibility of obtaining a higher dose intensity of chemotherapic drugs in districts or organs affected by advanced tumors, with less systemic side effects. Unfortunately, the uncertain results in terms of increasing survival and the default of effective devices are to be resolved for a wider application of the procedure.

[New therapeutic options in the treatment of hepatocellular carcinoma]

Hepatocellular carcinoma (HCC) is the fourth cause of death for cancer, the first in northern Africa and is the eighth tumor for incidence in the world. Risk factors are: liver cirrhosis, HBV, HCV and natural toxins (i.e. aflatoxin). A screening program is feasible and based on serum alpha-fetoprotein dosage and periodic liver ultrasonography. Instrumental diagnosis is based on ultrasonography associated with angiography or spiral TC associated with systemic portography. The best therapy of HCC is based on a multimodal approach: surgery when feasible, associated with or in alternative to intratumoral ethanol injection (PEI), transcatheter arterial chemoembolization (TACE), chemotherapy and radiotherapy. These different therapeutical approaches are related to the liver extent of the disease and liver functioning. Poor results obtained with chemotherapy led to research different therapeutical approaches as hormonal substances, immune modulators or genetic modulators. Most patients present with advanced disease, and their survival rate decreases with the increase of liver cirrhosis concomitant with HCC. Better results should be obtained with the use of different therapeutical approaches as angiogenetic inhibitors, today only for experimental use at present.

The influence of angiotensin-converting enzyme inhibitors on the aorta elastin metabolism in diet-induced hypercholesterolaemia in rabbits

Aortic elastin turnover is significantly accelerated in atherosclerosis, partly because of activation of the renin-angiotensin-aldosterone system caused by hypercholesterolaemia. We postulated that angiotensin-converting enzyme inhibitors (ACE-I) prevent the aortic elastin loss in experimental hypercholesterolaemia. Two doses of ACE-I (captopril, enalapril and quinapril) were used: a dose equivalent to that applied to human subjects and a dose 10 times higher. We found that the increase in serum and aortic elastolytic activity in cholesterol-fed rabbits was prevented by high-dose captopril. The elastin content in aorta homogenates from cholesterol-fed rabbits was significantly decreased. The higher dose of captopril, but no other ACE-I, prevented this decrease in aortic elastin content. In cholesterol-fed rabbits the elastin-bound calcium content was significantly elevated. The higher doses of captopril and enalapril lowered the elastin-bound calcium content. In serum and aortic homogenates of cholesterol-fed rabbits, ACE activity was elevated by 15% and 77%, respectively. Both doses of captopril, enalapril and quinapril prevented this cholesterol-induced increase in serum and aortic ACE activity. We conclude that: 1) administration of captopril at doses 10 times higher than those used in humans prevents hypercholesterolaemia increased aortic elastin loss. 2) higher doses of captopril and enalapril prevent the hypercholesterolaemia-induced increase in aortic elastin-bound calcium.

The influence of angiotensin converting enzyme inhibitors on lipid peroxidation in sera and aorta of rabbits in diet-induced hypercholesterolemia

In hypercholesterolemia increased lipid and lipoprotein peroxidation occurs. The renin-angiotensin system plays an important role in atherogenesis. Angiotensin II induces smooth muscle cells proliferation and stimulates oxidation of LDL particles and foam cell accumulation. Inhibition of ang II production leads to decrease in lipid peroxide production. The aim of this study was to assess the lipid peroxidation expressed as concentration of thiobarbituric acid reactive species (TBARS) in sera and aorta homogenates after administration of two doses of angiotensin-converting enzyme (ACE) inhibitors (captopril, enalapril and quinapril) in diet-induced hypercholesterolemia in rabbits. Sixty-four New Zealand rabbits were used. Animals were fed with standard fodder, special diet (1% cholesterol content) or special diet + tested ACEI. Two doses of ACE inhibitors were used: i), equivalent to applied to humans, ii), dose 10 times higher. The animals were divided into 8 groups: control, standard fodder; B, special diet; C1, C2, special diet + captopril in doses 2.5 and 25 mg/kg/24 h, respectively; E1, E2, special diet + enalapril in doses 0.75 and 7.5 mg/kg/24 h, respectively; Q1 and Q2, special diet + quinapril in doses 0.75 and 7.5 mg/kg per day, respectively. In cholesterol-fed rabbits and in groups receiving lower doses of tested ACE inhibitors, the serum TBARS concentration at 6 months was significantly higher in comparison to the control. The higher doses of enalapril, quinapril and captopril, prevented the cholesterol-induced rise in TBARS concentration. Lower dose of captopril attenuated the rise in TBARS concentration, it was significantly lower in comparison to group B, but higher than in the control group. In animals from groups B, E1, C1, Q1 TBARS concentration in aortae was significantly higher as compared to control group. Both doses of captopril and higher doses of enalapril and quinapril inhibited the rise of lipid peroxides concentration induced by cholesterol-rich diet.

Serum HDL cholesterol concentration in patients with squamous cell and small cell lung cancer

Cancer patients often present altered serum lipid profile including changes of HDL cholesterol level. The aim of our work was to evaluate serum level of HDL cholesterol in patients with squamous cell and small cell lung cancer and its dependence on histological type and clinical stage of lung cancer. Fasting serum level of HDL cholesterol was analysed in 135 patients with newly diagnosed lung cancer and compared to a control group of healthy men. All lung cancer patients, as well as subgroups of squamous cell and small cell lung cancer had statistically significantly lower HDL cholesterol concentration than controls. There were no statistically significant differences of HDL cholesterol level between the histological types or between clinical stages of each histological type of lung cancer.

[The influence of angiotensin-converting enzyme inhibitors on collagen content of the aorta wall in experimental hypercholesterolemia]

In atherosclerosis numerous qualitative and quantitative changes in connective tissue metabolism parameters in serum and aorta occur. In atherosclerosis there is an enhanced activity of local renin-angiotensin systems. It leads to overexpression of ANG II, both in serum and arterial wall. ANG II stimulates SMC to over-synthesize the collagens type I and III. Hyper-cholesterolemia is a form of metabolic injury which can both induce phenotypic change of SMC and activate RA system in arterial wall. ACEI lower the accumulation of collagens type I and III, and enhance elastin content in arterial wall in experimental hypertension. The aim of this study was to assess the influence of captopril, enalapril and quinapril on connective tissue metabolism of the aorta in experimental hyper-cholesterolemia. 64 male New Zealand rabbits were used. Animals were fed with standard fodder, special diet (1% cholesterol content) or special diet + tested ACEI. Two doses of ACE inhibitors were used: 1st--equivalent to doses applied to human subjects (in mg/kg of body weight), 2nd--dose 10 times higher. The animals were divided into 8 equal groups: K--standard fodder, B--special diet, C1, C2--special diet + captopril in doses 2.5 and 25 mg/kg/24 hours, respectively, E1, E2--special diet + enalapril in doses 0.75 and 7.5 mg/kg/24 hours, respectively, Q1 i Q2--special diet + quinapril in doses 0.75 and 7.5 mg/kg per day, respectively. The experiment lasted for 6 months. After 24 weeks the animals were sacrificed and aortae were excised for collagens assay. The statistical analysis was performed using ANOVA, followed by LSD test; p < 0.05 was considered statistically significant. The aorta collagens content of cholesterol-fed rabbits significantly increased. The tested ACEI (captopril, enalapril in both doses and quinapril in lower dose) had a preventive effect against the increase of aorta collagen content.

Serum total cholesterol and triglycerides levels in patients with lung cancer

Epidemiological studies indicate that low serum total cholesterol level may increase the risk of death due to cancer, mainly lung cancer. The aim of our study was to evaluate serum levels of total cholesterol (TC) and triglycerides (TG) in patients with squamous cell and small cell lung cancer and their dependence on the histological type and the clinical stage of the neoplasm. Lung cancer patients (n=135) and healthy controls (n=39) entered the study. All lung cancer patients had higher rate of hypocholesterolemia and lower TC and TG levels than the control group. TC concentration was lower in lung cancer patients and in both histological types in comparison with the control group, TG level was lower only in patients with squamous cell lung cancer. There were no statistically significant differences of TC and TG levels between the histological types, or between the clinical stages of each histological type.

Serum LDL cholesterol concentration and lipoprotein electrophoresis pattern in patients with small cell lung cancer

Epidemiological studies show that people with low level of total cholesterol have a greater risk of death due to cancer, predominantly lung cancer. The aim of our study was to evaluate serum level of LDL cholesterol and lipoprotein electrophoresis pattern in patients with small cell lung cancer and their dependence on clinical stage of the neoplasm. The studied group consisted of 34 patients with newly diagnosed small cell lung cancer and 39 healthy controls. Fasting level of LDL cholesterol was analyzed and lipoprotein electrophoresis was performed. There were no statistically significant differences of evaluated serum lipid parameters between lung cancer patients and controls, and between the clinical stages of small cell lung cancer.

The antioxidant enzymes activity in the conditions of systemic hypersilicemia

The effect of an excessive inorganic silicon oral intake on the activity of basic antioxidant enzymes was studied in rats. Activities of superoxide dismutase, catalase, and glutathione peroxidase were measured in liver and kidney tissues of animals receiving per os sodium metasilicate nonahydrate (Na2SiO3.9H2O) (Sigma, [St. Louis, MO]) dissolved in their drinking water. A decrease of the activity of all the studied enzymes was found in the samples derived from the experimental group. The results obtained indicate the free oxygen radicals participation in the potential pathologic events in the conditions of systemic hypersilicemia.

Modulation of elastase-like activity in fibroblasts stimulated with elastin peptides

Elastin-derived peptides, kappa-elastin, prepared by chemical degradation of insoluble elastin from bovine ligamentum nuchae, were shown to increase the elastase-like activity in the culture medium and cell fractions in fibroblasts. Preincubation of cells with nifedipine (calcium channel blocker) and trifluoperazine (calmodulin antagonist) induced a decrease in the activities of the enzyme under study. These data suggest the possibility of pharmacological modulation of the biological effects induced by elastin-derived peptides.

Pharmacological modulation of the antioxidant enzymes activities and the concentration of peroxidation products in fibroblasts stimulated with elastin peptides

1. Elastin peptides (kappa-elastin) prepared by alcoholic potassium hydroxide degradation of insoluble elastin were shown to increase the activities of antioxidant enzymes (SOD, CAT, GSH-Px) and the lipid peroxide concentration within fibroblasts. 2. The preincubation of cells with nifedipine (calcium channel antagonist) and trifluoperazine (calmodulin antagonist) caused the decrease in the activities of studied enzymes and the concentration of TBA-reactive products in fibroblasts stimulated with kappa-elastin. 3. The preincubation with ketotifen (antiallergic drug) has no effect on the activities of SOD, CAT, GSH-Px and the lipid peroxide concentration in stimulated cells. 4. These data suggest the possibilities of pharmacological modulation of the biological effects induced by elastin-derived peptides.