The morphology and application of stem cells in digestive system surgery

BACKGROUND

Stem cells constitute a group of cells which possess the ability to self-renew as well as the capacity to differentiate into a vast number of different cells within the human organism. Moreover, stem cells are able to undergo a potentially unlimited number of divisions and this characteristic is clinically essential. Specific fields of its application include treatment of diseases mainly in the field of haematology, orthopaedics, surgery, dentistry, and neurology.

MATERIALS AND METHODS

In the following work, the current knowledge concerning mechanisms of stem cell treatment in different parts of the digestive system with its diseases as well as adjacent therapy for surgery has been revised.

RESULTS

Stem cells therapy may be used in the treatment of various diseases of different parts of the digestive system. This also applies to the end part of the digestive tract (proctological diseases) because stem cells can be used to treat fistulas. Liposuction allows more recovery of mesenchymal stem cells, compared to previous bone marrow harvesting methods. Despite the application of stem cells in the treatment of different diseases used for many years so far, the therapeutic use for the regeneration of the gastrointestinal tract is still rare and unfamiliar.

CONCLUSIONS

Regenerative medicine seems to be a promising tool in medical research, especially when insulated cells and designed biomaterials are taken into consideration. Major points of discussion include types of stem cells, their origin or differentiation for the treatment of many diseases.

[The use of stem cells in some rheumatic diseases]

Stem cells (SC) are characterized by the possibility of a potentially unlimited number of divisions, that are, its self-renewal and differentiation pot in all tissues of the body. The term "stem cells" was first used by the Russian histologist Alexander Maksimova in 1908 in relation to the hematopoietic stem cell (HSC - haematopoietic stem cells). SC, because of their ability to self-renewal and proliferation enormous potential, became the subject of numerous research around the world. These studies offer hope for improving the prognosis and optimization methods for the treatment of many types of diseases, including diseases of the developing autoimmune which include rheumatic diseases. Pain associated with the most common rheumatic diseases, like rheumatoid arthritis and osteoarthritis, cause temporary restriction of efficiency, frequent use of sick leave and abuse of painkillers. Rheumatic diseases often have young people in the labor force, have a chronic condition, and despite of the treatment over time lead to permanent disability and even premature death. Therapy with stem cells, can become an effective alternative to standard therapies used so far. The results of the first studies on the use of stem cells are promising and warrant further work on their application not only in rheumatic diseases.

Influence of delays in diagnosis and treatment on survival in small cell lung cancer patients

The purpose of this study was to evaluate the influence on survival of delays in the diagnosis and treatment in an unselected population of small cell lung (SCLC) patients. Demographic and disease data of 3,479 SCLC patients were registered in the National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland during 1995-1998. In 50 % of patients, treatment started within 78 days from the appearance of first symptom(s). The median delay was 30 days (mean 47 days) and the median referral delay to a specialist was 19 days (mean 36 days). Half of SCLC patients were diagnosed during 34 days (mean 55 days). The mean time elapse from the diagnosis to the onset of therapy was 30 days (median 6 days). The multivariate analysis revealed that male gender-HR (hazard ratio = 1.2), ECOG Performance Status of 2 (HR = 1.5) and 3 + 4 (HR = 2.4), and clinical stage III (HR = 1.3) and IV (HR = 1.9) of the disease were independent negative predictors of survival. The patients treated with surgery and combined modality treatment had a better prognosis than those treated with chemoradiotherapy (HR = 1.6), chemotherapy (HR = 2.5), symptomatically (HR = 4.0), or those who refused therapy (HR = 3.9). The delay in the diagnosis and treatment had no effect on survival. Interestingly, patients who were diagnosed faster (below 42 days) actually had a worse prognosis than those diagnosed later. We conclude that a prolonged workup of SCLC patients and an extended time for treatment onset have a positive influence on survival, which may likely have to do with the determination of disease stage and more targeted treatment.

Influence of sera from interstitial lung disease patients on angiogenic activity of mononuclear cells

Chronic inflammation stimulates of neovascularization. The aim of this study was to evaluate the effect of sera from interstitial lung diseases (ILD) patients on angiogenic capabilities of different subsets of mononuclear cells. Serum samples were obtained from 22 patients with sarcoidosis, 20 with hypersensitivity pneumonitis, 20 with idiopathic pulmonary fibrosis, 9 with systemic sclerosis, 6 with pulmonary Langerhans cells histiocytosis, and from 20 healthy volunteers. Animal model of leukocyte induced angiogenesis assay was used as an angiogenic test. The pattern of angiogenic reaction was different in different diseases. Sera from systemic sclerosis and pulmonary Langerhans cells histiocytosis patients exerted inhibitory effects on angiogenesis, but sera from sarcoidosis, hypersensitivity pneumonitis, and idiopathic pulmonary fibrosis patients stimulated angiogenesis. Sera from sarcoidosis and pulmonary Langerhans cells histiocytosis primed monocytes for the production of angiogenic factors. The number of microvessels created after incubation of mononuclear cells depleted of monocytes with sera from systemic sclerosis patients significantly decreased. We conclude that the role of monocytes in the modulation of angiogenesis varies depending on the type of ILD. Sera from sarcoidosis stimulate and from pulmonary Langerhans cells histiocytosis patients inhibit neovascularization induced by monocyte mediators. Sera from systemic sclerosis inhibit angiogenesis induced by lymphocyte products.

Angiogenic activity of sera from interstitial lung disease patients in relation to pulmonary function

OBJECTIVE

Chronic inflammation and fibrosis are characteristic of interstitial lung diseases (ILD) and are accompanied by neovascularisation. The aim of this study was to examine the relationship between the angiogenic activity of sera from ILD patients and pulmonary function tests.

MATERIAL AND METHODS

Serum samples were obtained from 225 ILD patients: 83 with sarcoidosis, 31 with idiopathic pulmonary fibrosis, 29 with extrinsic allergic alveolitis, 16 with collagen vascular diseases, 13 with scleroderma with pulmonary manifestations (SCL), 14 with Wegener's granulomatosis (WG), 12 with silicosis, 12 with pulmonary Langerhans cells histiocytosis, 10 with drug-induced pulmonary fibrosis, 5 with cryptogenic organizing pneumonia, and 36 healthy volunteers. An animal model of leukocyte induced angiogenesis assay was used as an angiogenic test. In all patients spirometry, whole body plethysmography, static lung compliance, and single breath diffusing capacity of the lungs for carbon monoxide (DLco) were performed.

RESULTS

The angiogenic properties of sera from ILD differed, depending on the disease. In the examined ILD, the most important functional disturbances were decreases in static compliance and DLco. The correlation between DLco and angiogenic activity of sera was observed (P<0.05).

CONCLUSIONS

The data show that sera from ILD patients constitute a source of mediators modulating angiogenesis. Angiogenic activity of sera of ILD patients is related to DLco.

Angiogenic activity of sera from interstitial lung disease patients in relation to clinical and radiological changes

Objective

Clinical symptoms and radiological changes are useful in monitoring patients with interstitial lung diseases (ILD). Neovascularization participates in the pathogenesis of idiopathic pulmonary fibrosis and other ILD. The objective of the study was to examine the relationships between angiogenic activity of sera from ILD patients and clinical or radiological status.

Material and methods

Serum samples were obtained from 83 patients with sarcoidosis, 31 with idiopathic pulmonary fibrosis (IPF), 29 with hypersensitivity pneumonitis (HP), 16 with collagen diseases with pulmonary manifestation (CD), 13 with scleroderma (SCL), 14 with Wegener's granulomatosis (WG), 12 with pulmonary Langerhans cell histiocytosis (HIS), 12 with pneumoconiosis (PNC), 10 with drug-induced lung disease (DLD), 5 with cryptogenic organizing pneumonia (COP), and from 36 healthy volunteers. As an angiogenic test we used a cutaneous angiogenesis assay according to Sidky and Auerbach. Clinical status was evaluated using a special questionnaire. In all patients chest radiographs were performed.

Results

The angiogenic properties of sera from ILD differed depending on the clinical diagnosis. The strongest proangiogenic effect was induced by sera from patients with HP (mean number of new vessels 16.8), CD (16.6), sarcoidosis (16.3), IPF (16.2), and PNC (15.7). In the case of DLD (13.2), the effect was comparable to healthy controls (13.5). In contrast, sera from SCL (mean number of the vessels 10.5) and HIS patients (10.8) significantly inhibited angiogenesis compared with controls. The angiogenic activity of sera from patients with hilar or mediastinal lymph nodes involvement was higher than that of sera from patients with lung fibrosis. There were also differences in the serum angiogenic activity in relation to the severity of dyspnea.

Conclusions

The data showed that sera from ILD patients constitute a source of mediators modulating angiogenesis, but the pattern of reaction is different in various diseases. Sera from HP, sarcoidosis, IPF, and CD patients demonstrated the strongest proangiogenic activity. However, sera from SCL and HIS inhibit angiogenesis. Angiogenic activity of examined sera was related to the clinical and radiological changes.

Angiogenic activity of sera from patients with systemic autoimmune diseases in relation to clinical, radiological, and functional pulmonary status

Systemic autoimmune diseases, such as vasculitis and collagen diseases, are characterized by chronic inflammation. Mutual interrelationship between angiogenesis and chronic inflammation has already been demonstrated. The aim of the study was to examine the effect of sera from patients with systemic autoimmune diseases on angiogenesis induced by human mononuclear cells. The study population consisted of 43 patients with a systemic autoimmune disease associated with pulmonary manifestations, divided into three groups: 14 with Wegener's granulomatosis (WG), 13 with systemic sclerosis (SS), and 16 with collagen vascular diseases (CVD) such as rheumatoid arthritis, systemic lupus erythematosus, and dermatomyositis. The control group consisted of 15 healthy volunteers. Clinical status was evaluated using a questionnaire. Standard chest radiographs were performed in all patients. Pulmonary function tests were performed according to the ERS standards. An animal model of a leukocyte-induced angiogenesis assay was used as an angiogenic test. Sera from WG and CVD patients significantly stimulated angiogenesis compared with healthy subjects (P<0.001). On the other hand, sera from healthy donors exerted a proangiogenic effect compared with PBS. In contrast, sera from SS patients significantly (P<0.001) inhibited angiogenesis compared with sera from healthy subjects and PBS. Proangiogenic effect of sera from systemic diseases patients depended on radiological changes. No significant correlation between a degree of dyspnea or functional pulmonary tests and the number of new vessels or angiogenesis index was found. Sera from patients with systemic autoimmune diseases and healthy people constitute the source of mediators modulating angiogenesis. These modulatory effects differ depending on the disease entity.

Angiogenic activity of sera from silicosis and pulmonary Langerhans cell histiocytosis patients in relation to lung function tests

Angiogenesis has been implicated in the pathogenesis of interstitial lung diseases. A correlation between serum angiogenic cytokines level of patients with idiopathic pulmonary fibrosis and radiographic manifestations or functional pulmonary changes has been described, but the role of angiogenesis in the pathogenesis of other interstitial lung diseases such as silicosis and pulmonary Langerhans cell histiocytosis remains unclear. The aim of the study was to examine the effect of sera from silicosis and pulmonary Langerhans cell histiocytosis patients on angiogenesis induced by human mononuclear cells (MNC) in relation to pulmonary function. The study population consisted of 12 patients with silicosis, 12 patients with pulmonary Langerhans cell histiocytosis (PLH), and 14 healthy volunteers. Spirometry, whole-body plethysmography, static lung compliance (Cst), and diffusing capacity of the lung for CO (DL(CO)) were performed in all patients. As an angiogenic test, leukocyte induced angiogenesis assay according to Sidky and Auerbach was used. Sera from PLH patients exerted a significant inhibitory effect on angiogenesis (P<0.001). Sera from silicosis patients significantly (P<0.001) stimulated angiogenesis compared with sera from healthy donors. However, sera from healthy donors significantly stimulated the angiogenic activity of MNC compared with the control with PBS. The mean value of DL(CO) was significantly lower in the group of patients with PLH compared with patients with silicosis (P<0.05). A significant correlation between angiogenesis index and DL(CO) was observed (P<0.05). No significant correlation between the angiogenesis index and other functional parameters was found. Sera from interstitial lung diseases patients and healthy donors constitute a source of mediators modulating angiogenesis. Sera from silicosis patients stimulate neovascularization but sera from PLH patients exert an inhibitory effect on angiogenesis. A correlation between serum angiogenic activity and DL(CO) was found.

Modulatory effect of sera from sarcoidosis patients on mononuclear cell-induced angiogenesis

Sarcoidosis (SAR) is a systemic granulomatous inflammatory disease characterized by recruitment and activation of peripheral blood mononuclear cells to the sites of disease. Neovascularisation is a principal vascular response in chronic inflammation and hypoxia. The aim of the study was to evaluate the effect of sera from sarcoidosis patients on angiogenic capability of different subsets of normal peripheral human mononuclear cells (MNC) in relation to IL-6 and IL-8 serum levels, to radiological stages of disease and to the presence of extrapulmonary changes. Serum samples obtained from 42 sarcoidosis patients were examined. There were 12 patients in stage I, 16 patients in stage II, and 14 in stage III. In order to quantify angiogenesis, a leukocyte-induced angiogenesis assay was performed by a method of Sidky and Auerbach. MNC were depleted in monocytes by glass adherence and phagocytosis of iron particles techniques. IL-6 and IL-8 in sera from sarcoidosis patients were evaluated by an ELISA-based assay. Sera from sarcoidosis patients enhanced angiogenic capability of normal MNC significantly stronger than sera from healthy donors (P<0.001). Angiogenic activity of sera in sarcoidosis depended on the stage of disease and appeared most pronounced in stage II (P<0.05). Sera from patients with extrapulmonary changes exerted stronger effect on angiogenesis than sera from patients with thoracic changes only (P<0.001). IL-6 and IL-8 serum level correlated with each other, but no correlation was found between IL-6 and IL-8 serum level and angiogenic activity of the examined sera. Removal of monocytes from MNC eliminated the effect of sera from sarcoidosis patients on angiogenesis compared with the effect of these sera on intact MNC (P<0.001). Sera from sarcoidosis patients and from healthy people constitute a source of mediators participating in angiogenesis. Sera from sarcoidosis patients prime monocytes for production of proangiogenic factors.

Constrictive bronchiolitis obliterans in patient with Castelman’s disease

A 37-year-old woman with hialin- vascular type Castelman’s disease (CD) localised in the retroperitoneal region, incompletely resected, developed progressive dyspnoea. The chest radiograph taken 3 months before the operation was normal. The chest CT scan revealed diffused bronchiectases, hyperinflation and air trapping. Pulmonary function tests disclosed severe obstructive impairment with hyperinflation. The bronchoscopic examination of the bronchial tree was normal. Cultures of sputum, bronchial washing and blood were negative. No pemphigus antibodies were found. Mycoplasmal, chlamydial and viral infections were excluded. Histological examination of specimens obtained by open lung biopsy revealed bronchiolar inflammation, submucosal bronchial fibrosis with obliteration of bronchiolar lumen. Constrictive bronchiolitis obliterans (CBO) was diagnosed. Despite slight clinical and spirometric improvements that were achieved due to corticosteroid therapy, one year later she died as a result of respiratory failure. It is widely known that patients with CD develop CBO during the course of paraneoplastic pemphigus. However we present the case of CBO and CD but without any symptoms of this condition.

Organising pneumonia caused by transtuzumab (Herceptin) therapy for breast cancer

The case of a 49-yr-old female, who developed fever, effort dyspnoea and cough, with patchy migratory bilateral pulmonary infiltrates 6 weeks after starting transtuzumab therapy, following breast-conserving surgery with adjuvant chemoradiotherapy and hormone therapy for breast carcinoma, is reported here. Chest radiograph and thin section computed tomography demonstrated alveolar opacities with air bronchogram in both lungs. A lung biopsy was performed in a nonirradiated area of the contralateral lung and revealed a typical histological pattern of organising pneumonia (previously known as bronchiolitis obliterans organising pneumonia). Transtuzumab therapy was discontinued and subsequent gradual clinical and radiological improvement was observed. After 3 months, complete resolution of symptoms and radiographical abnormalities were noted. This is the first case report that suggests that transtuzumab therapy might induce the development of lung infiltrates with the histological appearance of organising pneumonia.

[Invasive aspergillosis in autopsy material of patients treated at the Institute of Tuberculosis and Chest Diseases during the years 1993-2000]

The aim of this paper is an analysis of clinical documentation and results of autopsy of 21 patients (pts) who died of invasive aspergillosis (IA) in the Institute of Tuberculosis and Chest Diseases in years 1993-2000 and the assessment of predisposing factors for IA. In 17 pts IA was the main and in other 4 only an accessory cause of death. All pts were treated with corticosteroids and/or cytostatic drugs--because of lung cancer (11 pts), cancer in other site (2 pts), haematologic disorders (2 pts), Wegener's granulomatosis (1 pt), polymyositis (1 pt), idiopathic pulmonary fibrosis (1 pt) and other diseases (3 pts). In 15 out of 21 pts granulocytopenia was revealed (from 0.008 x 10(9)/L to 0.82 x 10(9)/L) on an average one month before death. In 15 pts IA was limited to the lungs, in 6 others there were also fungal lesions in brain, kidneys, liver, spleen and heart. Pts with disseminated form of IA had significantly lower granulocyte count and were treated with higher doses of corticosteroids than others. Immunosuppressive drugs and granulocytopenia can be regarded as predisposing factors. Fatal course of IA depended also on the late diagnosis.

[Lung cancer--diagnosis and therapy delay]

It is commonly known that in the course of neoplastic disease a diagnosis and therapy should be perform as fast as possible. It is particularly important for lung cancer patients. The goal of this study was to assess the diagnosis and therapy delay in unselected group of lung cancer patients, registered in Pulmonary Outpatients Clinics in all parts of Poland.

MATERIAL

20,561 lung cancer patients were registered in Pulmonary Outpatients Clinics in all parts of Poland from 1995 to 1998.

RESULTS

The median delay caused by patients was about 46 days. In 33 provinces symptoms of the disease preceded diagnosis 28 to 50 days and in other 26 provinces--50 to 75 days. The median delay caused by doctors (time between first visit to the doctor and the date of diagnosis) was 65 days. In 35 provinces it was 30 to 70 days and in other 14 provinces this delay was between 70-111 days. The median time between first visit to the doctor and the beginning of therapy was 84 days. The median time between diagnosis and therapy was 30 days. Because chest physicians were also involved in the diagnosis and treatment of lung cancer patients, so for patients registered in years 1996-1998 the causes of delay connected with the function of this medical speciality were assessed. Median time between first visit to the doctor and first visit to the chest specialist was 38 days. Median delay to bronchoscopy was 26 days and to the diagnosis 46 days.

CONCLUSION

Delay of diagnosis and therapy vary widely among different provinces of Poland. The delay generated by family doctors and chest physicians are very important and require a deeper evaluation on the province level in the future.

Lung cancer in women: age, smoking, histology, performance status, stage, initial treatment and survival. Population-based study of 20 561 cases

BACKGROUND

The community-based cancer registry was set up and results were analysed to assess differences in clinicopathological parameters between women and men.

PATIENTS AND METHODS

The Pulmonary Outpatient Departments supplied data on 20 561 lung cancer patients diagnosed in Poland from 1995 to 1998. Data regarding demographics, smoking, histology, treatment and survival were obtained.

RESULTS

There were 2875 women and 17 686 men with lung cancer. Women were younger than men (60.02 versus 62.18 years; P <0.001). Age <50 years was more frequent in women than in men (23.3% versus 12%; P <0.001). Women with small-cell lung cancer (SCLC) and adenocarcinoma were significantly younger than women with squamous cancer (58.2 and 58.2 versus 61 years; P = 0.05). Also, men with adenocarcinoma and SCLC were younger than men with squamous cancer (60.6 and 60.2 versus 62.3 years; P = 0.05). Squamous cancer was the predominant type of lung cancer both in women (32.5%) and men (55.2%). However, SCLC (26.6% versus 19.9%: P <0.001) and adenocarcinoma (21.6% versus 9.6%; P <0.001) were more frequent in women than in men. Women were more frequently non-smokers than men (18.8% versus 2.4%; P <0.001). Adenocarcinoma patients smoked less intensively than patients with squamous and SCLC both in women (31.4 versus 35.8 and 33.7 packs/year; P <0.02) and in men (38.2 versus 42 and 41.9 packs/year; P <0.002). In multivariate analysis, bad performance status, advanced stage, non-surgical treatment, age >50 years at diagnosis and male gender were significant independent negative prognostic factors.

CONCLUSIONS

Lung cancer was six times more frequent in men than in women. Women with lung cancer were younger than men and smoked less intensively. Over-representation of adenocarcinoma and SCLC was observed in the women. Women with lung cancer had a better prognosis than men.

Breast cancer--the diagnostic and therapeutic problem

The progress made in recent years in the diagnostics of breast cancer, the universal character of mammographic and ultrasonographic screening examinations and the growth of social awareness with respect to this disease have caused a great deal of diagnostic problems. Cases of big, ulcerating cancer tumours, which infiltrate skin have now become history, and are reported sporadically. However, physicians are now facing the problem, which is the diagnosis of 1-5 mm changes detected in examinations. The necessity to diagnose small tumours in combination with 80-90% mammographic sensitivity reported compelled clinical physicists to verify these changes with histopathological examination. In the cases when the clinical examination, the result of a mammographic examination and that of fine needle aspiration biopsy do not provide a coherent picture, a surgeon has to qualify a patient for tumorectomy with an intra-operative study. In the years 1997-2000, 173 breast tumorectomies were made. Patients with benign neoplasm (e.g. adenofibroma, papilloma mammae) or patients with arousing suspicion of oncological anxiety breast tumour were qualified for surgical procedures. Operations were performed in one-day surgery conditions and intra-operative examination was performed in every case. In cases of non-palpable tumours, which were visible in ultrasonography or mammography the changes were marked by an "anchor" in order to be removed and examined histopathologically. The operated patients were 17-89 years old. In the obtained 173 tissue fragments dysplasia benign was recognized in 47.98% of cases, in 42.2% adenofibroma, in 2.31% papilloma mammae, in 1.73% mastitis chronica, in 4.62% ca ductale invasivum and in 1.16% ca ductale in situ has been observed.

Free radicals-induced morphological changes in the pancreas

Oxidative stress occurs whenever there is an imbalance between the generation of free radicals and the antioxidant defense. Oxygen is cytotoxic if oxygen concentration is higher than its amount in the atmosphere. This phenomenon is called hyperoxide process. This experiment was performed to determine the influence of normobaric hyperoxide process on peroxidation occurred in the rat's pancreas. Furthermore, the aim of this study was to estimate morphological changes in the pancreas. The studies were carried out on 44 male Wistar strain rats with the initial body weight of 230-250 g. After acclimation period the animals were divided into four experimental groups of 11 in a group. The exposure period of the influence of chemically pure oxygen was the base of the classification of rats into experimental groups labelled as follows: I, II, III. The time of exposure was 12, 24 and 48 hrs, respectively. The animals were dissected immediately after decapitation. The internal organs were investigated during autopsy. The whole pancreas with surrounding fatty tissue and peritoneum was cut out. Ultrastructural identification of different cell types required examination of several sections from each block and careful examination of numerous selected photographs. The histological preparations were evaluated in electron microscope. Histological evaluation revealed the presence of changes which seem to be adaptative and temporary. The B cells of Langerhans' islets were more damaged than other endocrine cells.

Estrogen-dependent activity of kidney lysosomal proteolytic enzymes

Drug-induced kidney injury is a potential complication of a number of medicaments. The wide-spread use of estrogens in the form of oral contraceptives and in the form of hormonal replacement therapy, has necessitated extensive studies on the biochemical alterations. The following effects of estrogens on kidney are discussed in greater detail with special regard to enzyme induction. The aim of the study was to evaluate the influence of long-term activity estrogens on kidney lysosomal enzymes like cathepsin B, D and L. Female rats were divided randomly into eight experimental groups. Oestradiolum benzoicum was used for the purpose of this study. Estrogens were given i.m. one time per week for 8 weeks in different doses, respectively: E1--0.00075 g/kg b.w., one time per week; E1.1--0.00075 g/kg b.w. every three days; E2--0.0015 g/kg b.w.. one time per week. E2.1--0.0015 g/kg b.w.. every three days; E3--0.03 g/kg b.w.. one time per week; E3.1--0.003 g/kg b.w.. every three days; KO--untreated animals; K1--treated control, rats received oleum pro injection at the dose of 1.2 ml/100 g b.w. The activity of free and bound fractions of lysosomal enzymes, such as cathepsin B, D and L were assayed in kidney homogenates using spectrophotometric methods. Differences between various experimental groups were tested with ANOVA test. The activity of cathepsin B, D and L fractions showed significant changes compared to control groups. The observed changes were not characteristic in all the studied groups. The most important changes referred to the activity of cathepsin B and D. Differences were noted between the enzymes activity in animals treated with the smallest dose of estrogen and that in control groups. It was smaller in group E1 than in groups K0 and K1. The activity of cathepsin B was higher in group E1 than in control groups. There was no correlation between the dose of injected estrogens and the observed lysosomal activity changes. The changes in lysosomal activity were uncharacteristic.

C-reactive protein (CRP) as a response to postoperative stress in laparoscopic cholecystectomy using the abdominal wall lift, with performed pneumoperitoneum (CO2), and in open cholecystectomy

The first laparoscopic cholecystectomy was performed thirteen years ago and rapidly became the preferred way of operation in patients suffering from cholelithiasis. The pneumoperitoneum can be responsible for haemodynamic disorders. The abdominal wall lift is an alternative way for pneumoperitoneum during laparoscopic cholecystectomy. The aim of this study was the comparative analysis of operative trauma response in the patients treated by laparoscopic cholecystectomy using abdominal wall lift and in cases which underwent open cholecystectomy or laparoscopic operation using pneumoperitoneum. The concentration of C-reactive protein was measured in patient serum before and twice after surgery. The obtained data underwent a statistic analysis. In all cases the surgery caused the marked changes of CRP-concentration. The mean level of CRP was higher three times in patients after open cholecystectomy than in cases treated by laparoscopic cholecystectomy with the use of abdominal wall lift or with performed pneumoperitoneum. During the experiment the statistically significant different between laparoscopic surgery with the use of the laparolift and laparoscopic with earlier performed pneumoperitoneum was observed. The stress and inflammatory response in cholecystectomy using abdominal wall lift was significant but smaller than the response noted in open cholecystectomy and similar to the response observed after pneumoperitoneum. The replacement of pneumoperitoneum by abdominal wall lift does not change the operative stress in laparoscopic cholecystectomy.

The relationship between estrogen and the development of liver vascular disorders

The liver is central to the metabolic disposition of all drugs and foreign substance. Drug-induced liver injury is a potential complication of estrogen preparations. The primary estrogen-induced vascular disorders are peliosis hepatis and vasculitis. Peliosis hepatis has been described as a rare consequence of taking estrogens and contraceptive. This condition is characterized by the presence of blood-filled spaces. Vasculitis has been noted as necrotizing or non-necrotizing hypersensitivity and an inflammatory infiltrate involving all the wall of a vessel. Vasculitis is usually connected with the presence of increased numbers of eosinophils either in blood or tissues. The aim of the study was to determine the influence of estrogen preparations on liver vascular disorders. The experiment was conducted on female rats of Wistar strain with the initial body weight of 180-300 g/kg of the body weight. After acclimation period, animals were gathered in 5 experimental groups of min. 10 in the group. Oestradiolum benzoicum was used for the purpose of this study. It was given i.m. once a week for 8 weeks in three different doses: E1--0.0075 g/kg, E2--0.0015 g/kg; E3--0.003 g/kg of the body weight. Two control groups were designed: K0--the untreated animals, K1--the animals receiving the adequate quantity of oleum pro injection. Fragments of organ assigned for histological examination were fixed in 10% buffered formaldehyde solution and transformed into paraffin sections. Histological preparations were evaluated in the light microscope. The histological assays were determined using: hematoxylin-eosin, azan and histochemical paS (periodic acid-Schiff) stains. In the described experiment large inflammatory infiltrations and vasculitis (E2, E3) were observed. In the animals treated with higher doses of estrogens diffusely distributed infiltrations around spaces with bloody fluid inside were revealed. The lumen of vessels was dilated. Estrogens can be responsible for the development of vascular disorders described as peliosis hepatis. The observed changes were suggestive of drug related vasculitis. An increased awareness of peliosis hepatis may become an important symptom for a pathologist, especially in patients at risk.

The secondary hemodialysis vascular access created through the basilic vein transition on the forearm

Hemodialysis vascular access related problems account for most hospitalizations in chronic hemodialysis patients. Having exhausted classic, primary radio-cephalic fistula on the forearm the secondary vascular access can be created. The secondary access was achieved through a subcutaneous displacement of the basilic vein and through surgical creation of end-to-end fistula between this venous and radial artery on the forearm. The subject of the study were eight patients undergoing chronic hemodialysis. In all patients the type of anastomosis and early and late complications were studied. The preferred route for exposure of the basilic vein was making the single incision along the forearm. Next, the basilic vein was transferred to the subcutaneous tunnel on the anterior side of the forearm. In four cases the classic end-to end anastomosis between the basilic vein and radial artery was performed. In other four patients, the telescopic method of fistula creation was done. In all eight cases the regular flow was observed. In postoperative period no complications were noted.

The obtention of vascular access on the arm for hemodialysis

The chronic dialysis is the way of replacing the lost kidney function. Well functioning vascular access is the prerequisite for chronic hemodialysis treatment. The arteriovenous fistulas are the optimal form of vascular access. In patients, in whom the usual sites for fistula have been exhausted the vascular fistula on the arm was placed. 53 dialysis accesses were performed on the arm between 1989 and 1999. All subcutaneous fistulas were created by the junction of the cephalic vein with brachial artery, just above the cubital fossa on the anterior surface of the arm. All anastomoses were created in the operating room under local anesthesia. The preferred route for exposure of cephalic vein was making the single incision along the arm. When the distal part of cephalic vein has been ligated and divided, the adequate space for the graft in the tunnel was performed. End-to-end anastomosis between the distal end of vein and side of brachial artery was completed using the suture material. In 50 hemodialysed patients the regular flow through the arteriovenous fistula was observed. Fistula thrombosis occurred in 2 cases. In 4 examined patients we observed blood extravasation in the subcutaneous tissue, where the tunnel was created. In 5 patients the local cellulitis was noted. The late vascular complications were evaluated in 15 cases. Aneurysms were revealed clinically in 3 patients and false aneurysm occurred in 2 patients. The described late complications required no surgical correction. The anterior side of the arm is the best place for arteriovenous access used for hemodialysis, in patient without the possibilities of surgical creation of the forearm's fistula.

Pathophysiologic role of oxygen-free radicals in toxic damage of the liver

The role of oxidative stress in toxic injury of the liver has been well documented. Molecular oxygen is indispensable for most of the living organisms but under specific conditions can be cytotoxic for all organisms. If oxygen concentration will be higher than its amount in the atmosphere, different pathological processes can occur in aerobic organisms. In normal hepatocytes, this physiologic oxidant stress is easily handled by mitochondrial defense. On the other hand, there are a lot of clinical indications to therapeutic application of both normobaric and hyperbaric hyperoxide processes. This work was undertaken to determine the influence of normobaric hyperoxide process on morphological structure of rat's hepatic cells. Furthermore, the aim of this study was to determine the degree of dependence between the time of hyperoxide process and morphological changes in the liver. The experiment was conducted on 44 male Wistar strain rats with initial body weight of 230-250 g. After acclimation period, the animals were gathered in experimental groups of 11 in a group. The exposure time of the influence of chemically pure oxygen was the base of the classification of rats into experimental groups labelled as follows: I, II, III. The time of exposure was 12, 24 and 48 hrs, respectively. The control groups also contained 11 animals. The animals were dissected immediately after decapitation. The whole liver was cut out. Fragments from the right central lobe and from the left lateral lobe of the liver were taken. The histological preparations were evaluated in electron microscope. In all the experimental groups adaptative and probably temporary histopathological changes were noted in the liver. The observed damages were probably reversible.

Lung cancer in patients under 50 years old

PURPOSE

The community based lung cancer registry was set up and the results were analysed to assess the differences in clinicopathological parameters and survival between patients under and over 50 years of age.

PATIENTS AND METHODS

The Pulmonary Outpatient Clinics supplied the data on 5404 lung cancer patients diagnosed in Poland in 1995. Data regarding demographic, smoking, histology, clinical stage, performance status, family history of cancer, therapy and survival were obtained.

RESULTS

At time of diagnosis 757 (14%) patients were under 50 years of age. In this group the frequency of females was higher as compared to this in the group of older patients (24.2% vs. 12.1%; P<0.001). Also the incidence of adenocarcinoma (12.6% vs. 7.6%; P<0.001) and small cell lung cancer (22.9% vs. 14.8%; P<0.001) were significantly higher in younger patients. Young patients had better performance status (55.4% vs. 46.6%; P<0.001) than old. The incidence of cancer in families of younger patients was higher both among the mothers (4.7% vs. 3.0%; P<0.001) and among the fathers (7.6% vs. 4.1%, P<0.001). Surgery or chemotherapy were more often applied to patients under 50 years in comparison to older ones (P<0.001). Young patients had better prognosis. Higher percentage of them survived one year (32.6% vs. 28.9%; P<0.049). In multivariate analysis, age over 50 at diagnosis, male gender, diagnosis of small cell lung cancer, advanced stage of the disease, bad performance status, and non-surgical therapy were independent negative prognostic factors.

CONCLUSION

Among young patients, overrepresentation of women, subjects with positive family history of cancer, with better performance status, with adenocarcinoma and small cell lung cancer were noticed. Young patients were treated more aggressively and had better prognosis than patients over 50 years of age.

[Lung cancer--differences of incidence between the sexes]

During the last decade increasing incidence of lung cancer among women have been observed in Poland. The aim of the study was to demonstrate differences among men and women with lung cancer. Lung cancer was diagnosed in 785 female and 4619 male in 1995 in Pulmonary Outpatients Departments. Women were younger than man when all histologic types of lung cancer were analysed (59.7 vs 61.9 years p. < 0.001). Particularly younger subjects were those with adenocarcinoma and small cell lung cancer (56.9 and 57.4 years for women and for men respectively 60.2 and 59.6 years, p < 0.001). Although squamous lung cancer was the most prevalent histological type among men (43.7%) and women (24.7%), about two times higher percentage of men had this neoplasm (p. < 0.001). Adenocarcinoma (18% vs 6.6%, p. < 0.001) and small cell lung cancer (18.5% vs 15.5% p. < 0.001) were prevalent in significantly higher percentage among female than male. Nonsmokers were more frequently noticed among women then men (20.4% vs. 1.9%, p. < 0.001), particularly those with adenocarcinoma. Also women smoked less intensively (33.6 pack/years vs. 42.3 pack/years, p < 0.001) except those with squamous cancer. The higher incidence of cancer was observed among mothers (7% vs 3.8% p. < 0.001) and fathers (7.1% vs 5.6%, p. < 0.001) of women than men with lung cancer.

[The role of sex as a prognostic factor in lung cancer]

The aim of this study was to demonstrate the prognostic role of the gender. Lung cancer was diagnosed in 785 female and 4619 male registered in Pulmonary Outpatients Departments in 1995. Women were younger than man when all histologic types of lung cancer were analysed (59.7 vs 61.9 years of age p. < 0.001), particularly those with adenocarcinoma(56.9 vs 60.2 years of age, p. < 0.012) and small cell lung cancer (57.4 vs 59.6 years of age, p. < 0.001). Although squamous lung cancer was the most prevalent among men (43.7%) and women (24.7%), about two times higher percentage of men had this neoplasm. Adenocarcinoma (18% vs 6.6%, p. < 0.001) and small cell lung cancer (28.5% vs 15.5% p. < 0.001) were prevalent in significantly higher percentage among female than male. Women were treated more aggressively by surgery (17.1% vs 14.1%, p. = 0.04) but similar percentage of men and women received radiotherapy, chemotherapy and multimodality treatment. Women more frequently survived one year (43% vs 35.7%, p. < 0.04). Significant and independent negative prognostic factors were: gender (RR-1.17 for men), age older than 50 age (RR-1.2), bed performance status (RR-3.28), disseminated disease (RR-2.78) small cell histological type of cancer (RR-1.21) and nonsurgical therapy (RR-3.29).

The effects of short-time caffeine administration on skeleton development in Wistar rats

The aim of the study was to evaluate the influence of caffeine on skeleton ossification in rats. Caffeine was administered in Tween 80 solution, once daily, in oral bolus, during the whole second trimester, in three doses: C1--0.7 mg/kg, C2--7.0 mg/kg, C3--70.0 mg/kg. On the 21st day of gestation the pumps were delivered. The fetuses were fixed in Bouin's solution and subsequently observed for external and internal malformation or in alcohol for skeleton malformation. The skeletons were stained with alizarin red-S. The examination showed an insignificant (P < 0.05) number of skeleton malformations, external haematomas and any internal malformations.

[Infection as a main or additional cause of death in patients treated for small cell lung cancer]

The aim of this study was to analyse the frequency of infection as a cause of death in small cell lung cancer (SCLC) patients. Our material consisted of 845 unselected SCLC patients, 246 women and 599 men, aged 29-78 years, treated between 1980-1994 in the Institute of Tuberculosis in Warsaw. 479 patients had limited and 366 extensive disease. 530 were in good (0-2) and 315 in bad (3-4) performance status. 784 patients died. Autopsy was done in 211 patients. Infection was regarded as a main cause of death in 39 patients (4.6%) and as a coexistent cause in 77 (9.1%). At the time of death from and/or with infection in 16 patients complete remission and in 27 partial remission of cancer was confirmed. The risk of death from and/or with infection was not related to the age and sex or to the performance status of patients and to extension of cancer. The risk of death from and/or with infection in the first 3 months of treatment was however greater for patients in bad performance status and with extensive disease and later (after 3rd months) for patients in good performance status and with limited disease.

[Predisposing factors for bronchiectasis--analysis of 69 patients treated in the years 1995-1999]

The aim of this study was to analyze the predisposing factors for bronchiectasis in 69 patients hospitalized in the 3rd Dept. of the Institute of TB and Lung Diseases in Warsaw in years 1995-1999. Bronchiectasis was diagnosed on the basis of the high resolution computed tomography (HRCT) scan. Among 69 patients at the age of 15-72 years there were 45 women (65%) and 24 men (35%). Fifty patients were nonsmokers. The most frequent predisposing factors of bronchiectasis in that group of patients were as follows: pneumonia (30.1%, in it recurrent pneumonia--19.3%, a single pneumonia--10.8%), sinobronchial syndrome (19.3%), pulmonary tuberculosis (12.1%), nontuberculous mycobacterial lung infections (7.2%), recurrent pneumonia and bronchitis in childhood (7.2%) and connective-tissue diseases (3.6%). Among other predisposing factors there were allergic bronchopulmonary aspergillosis, foreign body in bronchus, hypogammaglobulinemia and colitis ulcerosa.

[Evaluation of angiogenic activity in sera from patients with interstitial lung diseases]

Angiogenesis is a process of new blood vessels' formation occurring in many physiological and pathological conditions. Neovascularisation is the principal vascular response in chronic inflammation and concomitant fibrotic process. Microvascular changes in various organ sites in sarcoidosis (BBS) and some of the symptoms of the disease may be related to microangiopathy. Moreover, vascular alterations were also observed in lung specimens from idiopathic pulmonary fibrosis (IPF) and avian fanciers lung (AFL) patients. The present study was aimed at testing the effects of serum from 43 patients with ILD (24 BBS, 8 AFL, 8 IPF, 3 DIPF--drug induced pulmonary fibrosis) and 11 healthy controls on angiogenic capability of normal blood peripheral mononuclear cells (PBMC) in the murine intradermal angiogenesis assay (according to Sidky and Auerbach). The data demonstrated that sera from ILD patients significantly enhanced angiogenic capacity of normal PBMC as compared to control sera (p < 0.001). The effect was more pronounced for AFL patients than for BBS and IPF ones (p < 0.05). Sera from DIPF did not stimulate angiogenesis compared to control sera. The data showed that sera from ILD patients constitute sources of mediators participating in angiogenesis. This phenomenon may play role in pathogenesis of chronic immunological processes in lung.

[Cytostatic treatment of patients with advanced non-small cell lung cancer]

92 patients with advanced non-small cell lung cancer were treated with cisplatin 80 mg/m2 day 1 and etoposide 120 mg/m2 on days 1-3. In 58 of them vinblastine 5 mg/m2 was also applied on days 1 and 3. In 25% of all cases partial response and in another 26% minimal regression was found after 2 courses of chemotherapy, independently to treatment modality. Partial regression was observed significantly more often in patients with adenocarcinoma, but survival time was significantly shorter in this group. Median survival time was 8 months for all patients, 10 months for stage IIIB and 6 months for stage IV. This difference was significant.

[Analysis of patients registered in outpatient departments for tuberculosis and lung diseases in group VI N (neoplastic) during the first half of 1995]

2115 cases of chest neoplasms were registered during the first six months of 1995 in Pulmonary Outpatient Departments in Poland. In 865 (40.8%) patients squamous cell cancer was diagnosed, in 344 (16.2%)--small cell lung cancer, in 174 (8.2%)--adenocarcinoma, in 107 (5%) other types of lung cancer and in 5.6% of cases--lung cancer with undefined histology. Predominated subjects aged from 60 to 69 years (43.5%). Lung cancer under 50 years of age was observed significantly more often among women (25.8%) than among men (13.5%). Moreover adenocarcinoma was much more frequent among women than men and significantly more cases of lung cancer were recorded in nonsmoking women. Diagnosis was established during the first 4 weeks in 38.9% of patients but 23.6% of patients have waited for it more than 39 weeks. Surgical treatment was advised in 16.9% of subjects, radiotherapy in 14.3% and 26.4% of patients underwent chemotherapy. Treatment analysis was presented according histological type of lung cancer. Occupation, performance status, clinical stage of the disease, prevalence of cancer in patients families were also analysed.

[Coexistence of obstructive lung diseases and lung cancer]

Connection between histological type of lung cancer and existence of clinical and spirometric symptoms of COPD was analysed in 110 lung cancer patients (64 small cell, 23 adenocarcinoma, and 23 squamous). It was shown that adenocarcinoma was significantly more frequent among subjects with values of FEV1%VC over 70 than among subjects with small cell and squamous lung cancer. Also subjects with values of FEV1% VC over 70 had significantly higher oxygen blood pressure, and clinical and radiological symptoms of COPD were less intensive than in subjects with values of this index below 70. There was no correlation between histological type of lung cancer and bronchoscopic symptoms of bronchitis and radiological symptoms of emphysema.

Does chemotherapy-induced leukopenia predict a response in small-cell lung cancer?

The correlation between chemotherapy-induced toxicity and treatment outcome in cancer patients has not been studied thoroughly. Our aim was to evaluate whether there is any relationship between chemotherapy-induced leukopenia and response to treatment in small-cell lung cancer (SCLC). Data derived from records of 228 patients treated within two prospective multicentre phase II studies were analysed. In the first study (101 patients) chemotherapy included vincristine, epirubicin and cyclophosphamide and, in the second (127 patients), cyclophosphamide, etoposide and epirubicin; both regimens were given every 3 weeks. In the present analysis, the correlation between treatment outcome (response rate and survival) and highest scores of leukopenia within the first two and up to the fourth chemotherapy cycle, respectively, was evaluated. The objective response rate for the entire group was 66%; 53% in patients whose white blood cells remained normal and 85% in those who developed leukopenia within the first two cycles (P = 0.000). In multifactorial analysis, also including other treatment- and patient-related factors, independent correlation with response to chemotherapy was found for leukopenia (P = 0.001), chemotherapy regimen (P = 0.002) and the combined relative dose intensity (P = 0.018), but not for patient sex, age, performance status, pre-study weight loss, extent of disease and initial white blood cell count. Leukopenia within the first two cycles of chemotherapy was not correlated with survival, whereas such correlation for leukopenia occurring up to the fourth cycle was at the borderline level (P = 0.06). These findings suggest a relationship between chemotherapy-induced leukopenia and tumour response in SCLC.