Midterm follow-up study of laparoscopic dissection of uterine vessels for surgical treatment of symptomatic fibroids

BACKGROUND

This study aimed to assess laparoscopic dissection of uterine vessels (LDUV) for symptomatic fibroids in women.

METHODS

A total of 69 women entered the study between March 2000 and June 2003. In this case series, 68 consecutive women underwent LDUV using ultrasonically activated sheers or electrosurgery for the treatment of fibroids over 3 years (median follow-up period, 14.5 months). Ultrasound or magnetic resonance imaging was carried out 3, 6, 12, 24, and 36 months after treatment. The tissue markers, gonadotropin, and estrogen levels were studied postoperatively.

RESULTS

Almost all the patients (98.5%) had a successful LDUV with a low rate (7.3%) of postoperative complications. The time of surgery ranged from 15 to 50 min (mean, 30.8 min). The blood loss was minimal (mean, 14.7 ml), and the hospital stay was 2.4 days. Symptom improvement (menorrhagia or dysmenorrhoea) was 93.2%, and the average reduction in the dominant myoma was 57.8% during a follow-up period longer than 12 months. All the patients with anemia had normal red cell counts after 3 months.

CONCLUSIONS

Uterine volume and the dominant fibroid were significantly reduced and symptoms were improved by LDUV. The laparoscopic procedure is associated with insignificant tissue damage and normal gonadotropin and estrogen levels.

Salivary immunoglobulin A and G subclasses in HIV positive patients

Many of the opportunistic infections in HIV are related to the mucous membranes, but the protection of oral mucosal compartment mediated by IgA and IgG subclasses in saliva is still not well documented. Therefore, the aim of this study was to investigate the status of salivary IgA and IgG subclass in HIV positive patients. Levels of IgG1, IgG2, IgG3 and IgG4 were determined by ELISA and IgA1 and IgA2 by radial immunodiffusion in the resting whole saliva of 33 HIV patients and 21 HIV-seronegative healthy controls and were expressed in mg/L (IgA) and ug/L (IgG) of saliva. Salivary IgA2 was significantly reduced in the HIV positive patients (p<0.0009) when compared to the healthy controls, but no differences in salivary IgA1 level between HIV patients and healthy controls were found. On the other hand, salivary IgG1, IgG2, IgG3 and IgG4 subclasses were increased (p<0.0009) in HIV patients in comparison to the healthy controls. We can conclude that inspite of IgA2 deficiency which was found in studied HIV positive patients, mucosal antibody responses are quite normal and might not predispose development of oral opportunistic infections.

Phagocytic functions of salivary neutrophils in oral mucous membrane diseases

BACKGROUND AND PURPOSE

Phagocytic functions of salivary polymorphonuclear neutrophils (sPMNs) have not been comprehensively studied in patients with oral mucous membrane diseases, although available data suggest the role of immunity in their pathogenesis.

SUBJECTS AND METHODS

Phagocytic functions of sPMN were determined in 15 patients with acute recurrent aphthous ulceration (RAU), 11 patients with oral lichen planus (OLP) and 20 healthy volunteers. In healthy subjects, the same parameters were also determined in peripheral blood polymorphonuclear neutrophils (bPMNs). Phagocytic activity (proportion of ingesting cells, PA), ingestion ability (number of ingested targets per 100 phagocytes, IA) and intracellular microbicidity (proportion of killed targets, IM) of PMNs separated from peripheral blood and the whole unstimulated saliva were determined by acridine orange method with living yeast cells as targets.

RESULTS

Salivary PMNs in healthy individuals showed significant reduction in PA (33% vs. 76%; P < 0.009) and IA (0.47% vs. 2.93%; P < 0.009) and significant increase in IM (12.0% vs. 5.5%; P = 0.011) in comparison with bPMNs. In RAU patients, reduced PA (27% vs. 37%; P = 0.035) and IA (0.25% vs. 0.47%; P = 0.05) were detected, while in OLP patients enhanced IM was detected (12% vs. 19%; P = 0.033) in comparison with healthy controls.

CONCLUSION

Salivary PMNs present functional features distinct from those in peripheral blood. Some phagocytic functions of sPMNs are reduced in RAU and enhanced in OLP, indicating their role in pathogenesis or reflecting clinical changes in these conditions.

Salivary IgA and IgG subclasses in oral mucosal diseases

OBJECTIVE

It was hypothesized that serum levels of immunoglobulins may play a role in the pathogenesis of oral mucosal diseases, or reflect clinical changes in these conditions, but little is known about the role of salivary immunoglobulins in the pathogenesis of these diseases. The aim of this study was to investigate possible alterations in salivary immunoglobulin A (IgA) and IgG subclasses in patients with oral mucosal inflammatory diseases.

SUBJECTS AND METHODS

Levels of IgG1, IgG2, IgG3 and IgG4 were determined by enzyme-linked immunosorbent assay (ELISA), and IgA1 and IgA2 by radial immunodiffusion in the resting whole saliva of 31 patients with acute recurrent aphthous ulceration (RAU) (and followed in remission), 11 patients with chronic hyperplastic candidal infection (CHC), 12 patients with Sjogren's syndrome (SS), six patients with oral lichen planus (OLP), and 18 healthy volunteers using the normal saliva as a comparison point for all.

RESULTS

IgG and IgA subclasses were increased in OLP. In CHC all IgG subclasses were increased while IgA1 was decreased, IgG1, IgG3 and IgG4 levels were increased in SS, while all IgG subclasses as well as IgA2 were increased in acute RAU in comparison with healthy controls. No differences in any immunoglobulin subclasses between major and minor acute RAU were found. In remission, IgG1 and IgG4 returned to normal values while IgG2, IgG3, and IgA2 remained increased in patients with RAU.

CONCLUSION

Salivary immunoglobulin subclasses vary in different oral mucosal conditions and may play a role in oral mucosal inflammatory diseases and/or reflect clinical changes in these conditions.

Immune thrombocytopenic purpura in children

Immune thrombocytopenic purpura (ITP) is the most commonly acquired bleeding illness in children. 70-80% of children resolve from acute state within few weeks and months with a complete retrospective changes in recovery of reference values. The aim of this work was to evaluate a group of patients with diagnosis of ITP treated or followed from 1979 to 1999. There were found no differences in achieving the remission in the acute phase of ITP (this means till the 6th month from the first documented thrombocytopenia) according to retrospective analysis and comparison of three groups of children in whom the diagnosis of ITP was made from 1979 to 1991 (group A), from 1992 to 1994 (group B) and from 1995 to 1999 (group C). The groups differed in their therapeutic strategies in various time periods as to the time of the diagnosis. In group A, 75% of patients were treated with oral corticosteroids (prednisone). In group B, 10.8% of patients were treated with i.v. application of corticosteroids and 43.3% had no therapy in the acute phase. In group C, 28% of patients were treated with i.v. application of corticosteroids and 36.6% of patients had no therapy applied. A comparable degree of remission in the acute phase with 48%, 54%, or 50% of children with reference values of platelets at the time of six months from the beginning of the disease were achieved. In the group A, the remission was achieved in 85% of children at the end of the 5th year of the follow-up, in the group B in 75% of children to the latest control of platelets in our outcome clinic for children and follow up in the group C in 68% of children the remission was achieved after one year. (Tab. 4, Fig. 2, Ref. 10.)

Laparoscopic lymph node dissection using ultrasonically activated shears: comparison with electrosurgery

PURPOSE

To assess and compare perioperative parameters in two groups of patients treated by different laparoscopic techniques of lymph node dissection (LND) for gynecologic cancer.

PATIENTS AND METHODS

Between April 1996 and March 2001, 59 consecutive women with microinvasive cervical cancer (N = 5) or clinical stage I endometrial cancer (N = 54) underwent laparoscopic LND during a primary staging procedure using an electrosurgery (ELC) or ultrasonic (US) operative technique. The two groups were compared for perioperative outcomes. Differences between the two groups were determined by the Wilcoxon's rank-sum test.

RESULTS

Laparoscopic LND and other staging procedures were completed successfully in 58 women (98.3%). There were no statistically significant differences between the groups with regard to perioperative outcomes (operation time, time for LND, blood loss, hospital stay, complications), but there was a significant difference (P = 0.0008) in the number of lymph nodes harvested: a mean of 13.7 in the ELC group and 17.5 in the US group. The pathologists found that the reading of histology slides was easier after US dissections because of the greater depth of thermal injury in the lymphatic tissue in ELC group.

CONCLUSION

The US operative technique ensures efficient coagulation, cutting, dissection, and grasping for laparoscopic LND in patients with cervical and endometrial cancer.

Salivary levels of vascular endothelial growth factor (VEGF) in recurrent aphthous ulceration

BACKGROUND

Vascular endothelial growth factor (VEGF) is a multifunctional angiogenic cytokine involved in angiogenesis and wound healing. Its presence in recurrent aphthous ulceration has not been reported to date. The aim of this study was to investigate the association of salivary levels of VEGF with various stages of recurrent aphthous ulceration (RAU).

METHODS

VEGF levels were determined in a group of 27 age and sex-matched healthy controls and in 30 patients with minor and major RAU grouped into the three stages: (I) early active stage, (II) active stage, and (III) remission period. VEGF levels (pg/ml; mean +/- SD) in unstimulated whole saliva were determined by enzyme immunoassay.

RESULTS

Patients with major RAU - stages I and II - had decreased VEGF values (765 +/- 458 and 341 +/- 109, respectively) when compared both to healthy controls (1652 +/- 567; P < 0.01) and to stage III major RAU (1524 +/- 784; P < 0.005).

CONCLUSION

Salivary VEGF levels seemed to be associated with ulcer development in major RAU, showing stage-dependent alterations during the course of this disorder.

Laparoscopic staging of endometrial cancer using laparosonic instruments: comparison with electrosurgery

OBJECTIVE

To compare perioperative parameters in two groups of women with different laparoscopic operative techniques in surgical staging of endometrial cancer (EC).

STUDY DESIGN

Thirty randomly allocated and laparoscopically treated women with EC. Fifteen patients were operated by electrosurgery, 15 patients by laparosonic operative technique. Differences between the two groups were determined by the Wilcoxon rank-sum test. Probability (P) of less than 0.05 was considered significant.

SETTING

Department of Gynecology and Obstetrics, Endoscopic Training Center, Baby Friendly Hospital, Kladno, Czech Republic.

RESULTS

Laparoscopy was successfully completed in 29 patients. Laparoscopy-assisted surgical staging of EC was performed based on the tumor grade and the depth of myoinvasion. In both groups, in total 18 and 5 women underwent pelvic lymphadenectomy (PLN) and infra-aortic lymph node sampling (IALS), respectively. Three patients had metastases in pelvic lymph nodes. In the electrosurgical hemostasis and laparosonic group the mean total time required to finish the whole operative procedure were 132.1 and 138.3 min, respectively, with no statistically significant difference (P=0.96). There were no significant differences between the groups in any intraoperative or postoperative follow-up variables, except for the number of excised lymph nodes where the difference between electrosurgery and laparosonic group (12.7 versus 18) was statistically significant (P=0.05). In one patient with intraoperative venous bleeding the laparosonic hemostasis was ineffective (successful procedure rate 93.3%). One patient from the electrosurgery group was converted to laparotomy due to injury to the epigastric vessels. This complication had no connection with the surgical techniques studied.

CONCLUSION

It is concluded that both operative technique variants in laparoscopy-assisted surgical staging appear to be feasible and effective for patients with EC.

High-dose intravenous immunoglobulins for lupus nephritis--a salvage immunomodulation

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with a great diversity of clinical manifestations which is difficult to manage. IVIGs represent promising immunoregulatory agents with the ability to control SLE without subsequent predisposition to infectious complications. Despite the implied risk of developing renal failure due to IVIG, considerable beneficial effects on lupus nephritis are reported. In this review, the clinical and adverse effects, and mechanism of action, with special emphasis on modulation, of idiotypic network is discussed.

Effect of the nonsteroidal anti-inflammatory drug indomethacin on proliferation and apoptosis of colon carcinoma cells

PURPOSE

Nonsteroidal anti-inflammatory drugs lower the incidence of and mortality from colon cancer. In this paper, we present the effect of indomethacin on growth inhibition and alterations in the expression of several genes involved in cell cycle and apoptosis in CaCo-2 colon adenocarcinoma cells.

METHODS

We used the MTT test to evaluate the effect of indomethacin on the proliferation rate of colon cancer and normal fibroblast cells in vitro. The expression of c-myc oncoprotein and p53 and p27 suppressor proteins was examined using the immunocytochemical method.

RESULTS

We have shown that indomethacin reduces the proliferation rate of CaCo-2 colon cancer cells (up to 60% at the concentration of 4 x 10(-4) M), alters their morphology, and induces cell death by apoptosis. The most pronounced inhibitory effect was observed at the concentration of 6 x 10(-4) M where the growth was completely suppressed. However, the growth of normal fibroblasts (Hef 522) was much less inhibited (about 30% of inhibition at the concentration of 6 x 10(-4) M). Indomethacin reduces the proliferation rate and induces apoptosis in CaCo-2 colon cancer cells through enhanced expression of c-myc, p53, and p27 proteins.

CONCLUSIONS

This is the first report about p27-increased expression in colon carcinoma cells induced by indomethacin treatment. Increased expression of p27 represents a new mechanism of apoptosis in cells treated with NSAIDs (indomethacin). This effect probably contributes to the anti-proliferative effect on colon cancer cells in vitro.

Serum amyloid A protein (SAA) in colorectal carcinoma

The changes in serum levels of serum amyloid A protein were studied in 67 patients suffering from colorectal carcinoma and compared to three other major acute phase proteins: C-reactive protein, alpha1-antichymotrypsin and alpha1-acid glycoprotein. Although the presence of colorectal carcinoma caused an increase in serum levels of all the acute phase reactants studied, serum amyloid A protein showed the most powerful reaction in pre-operative disease stage, with the mean value of 330 mg/l (range 7-2506 mg/l) as compared to the normal values of <1.2 mg/l obtained in 30 healthy adults. The mean serum amyloid A protein concentration increased to 487 mg/l after surgery, declining during the post-operative clinical course until the sixth chemotherapy cycle (from 167 mg/l to 64 mg/l), but never returned to the normal range. In the later chemotherapy cycles, mean serum amyloid A protein increased to 163 mg/l, probably as a result of the disease relapse. According to the statistical relations among exact confidence intervals for proportions, serum amyloid A protein showed the best specificity for colorectal carcinoma of all the acute phase proteins studied (83-100%) and also a sensitivity of 100%. We concluded that serum amyloid A protein seems to be a reliable parameter, which could be recommended for clinical routine as a non-specific tumour marker for colorectal carcinoma.

Evaluation of genital human papillomavirus infections by polymerase chain reaction among Croatian women

Infection with specific human papillomavirus (HPV) types is the strongest risk factor in cervical carcinogenesis. In this study we analysed, by means of polymerase chain reaction (PCR), cervical specimens obtained from consenting women with abnormal Pap smears collected from 1996 to 1998. Consensus- and type-specific-primers directed PCR were used in order to detect the presence and to determine the most common HPV types: 6, 11, 16, 18, 31 and 33. Out of 1874 specimens, 1207 (64%) contained one or more HPV types. Approximately half HPVs were typed (621 out of 1207) and the others remained untyped (586 out of 1207), 51% and 49%, respectively. Beside low-risk HPV 6/11 (5%), the most frequently observed HPVs were high-risk HPV types, especially type 16 (12%), while HPV types 18 (2%), 31 (5%) and 33 (3%) were less frequent. The HPV positivity rate declined with age, although all HPV types were equally distributed in different age groups. The presence of HPV DNA significantly increased from 55% to 78% along with the severity of the cervical lesions, i.e. low- and high-grade squamous intraepithelial lesions (LSIL, HSIL). Undetermined HPV types, other than 6/11, 16, 18, 31 and 33 were equally distributed in LSIL and HSIL which indicates that they represent low- as well as high-risk HPV types. Our results indicated that HPV infections, especially those with HPV 16, represent a significant public health concern in Croatia.

[Autoimmune hemolytic anemia and chronic giant cell hepatitis]

The authors describe a case report of a six months old boy with autoimmune hemolytic anemia and giant cell hepatitis. This is a very rare syndrome in infancy. After eleven months of intensive immunosuppressive treatment (glucocorticoids, cyclosporin A, azathioprin, intravenous immunoglobulins, cyclophosphamid) no improvement of hemolysis was observed and therefore splenectomy was indicated. 1 year after the treatment was finished the patient is in good general condition and his hematologic and biochemical parameters are physiological.

Intravenous immunoglobulin treatment of lupus nephritis

OBJECTIVE

To evaluate the clinical response of treatment-resistant membranous and membranoproliferative lupus nephritis to intravenous immunoglobulin (IVIg).

METHODS

Seven lupus nephritis patients who failed to respond to at least prednisone and cyclophosphamide were studied. A kidney biopsy showing either membranous or membranoproliferative glomerulonephritis was available in six patients. They were treated with six courses (patients 1 and 2) or 1 or 2 courses (patients 3 through 7) of high-dose IVIg. For patients 3 through 7, the plasma levels of albumin, total cholesterol, urea, creatinine, dsDNA antibody titers, and daily proteinuria were measured just before the IVIg therapy, immediately on completion, and 6 months later.

RESULTS

All seven patients had a beneficial response to IVIg. In patient 1, decrease in proteinuria was evident 2 weeks after IVIg was started, nephrotic syndrome gradually disappeared, and she had no proteinuria in 3 years' follow-up. Decline in proteinuria was evident in patient 2 after the 4th IVIg course, but proteinuria reached the pretreatment level 4 months after the therapy ended. In patients 3 through 7, the mean daily proteinuria before IVIg (5.3 +/- 2.1 g) decreased after 1 or 2 IVIg courses (3.3 +/- 1.4 g), and further decreased when measured 6 months later (2.1 +/- 1.3 g). Similarly, the plasma cholesterol level decreased while the plasma albumin level increased after IVIg.

CONCLUSIONS

IVIg might be effective in treatment-resistant membranous or membranoproliferative lupus nephritis. Future studies should concentrate on determining the preferred treatment protocol of IVIg for the various classes of lupus nephritis.

The expression and role of insulin-like growth factor II in malignant hemangiopericytomas

Hemangiopericytoma is a rare soft tissue tumor originating from contractile pericapillary pericytes. To address the issue of molecular genetic events that participate in genesis and progression of hemangiopericytoma we analyzed insulin-like growth factor (IGF) II and IGF I receptor in 29 tumors collected from a human tumor bank network. Seven of these tumors were associated with severe hypoglycemia; six were retroperitoneal and one was located in the leg. Of 22 tumors tested 12 (54.5%) exhibited IGF II mRNA, while almost 90% (17 of 19) of hemangiopericytomas exhibited IGF I receptor mRNA. Sera from some patients whose tumors expressed IGF II mRNA contained elevated levels of IGF II. Removal of the tumor eliminated most of the IGF II immunoreactivity from the sera. The potential role of IGF II as a growth-promoting factor was examined on three malignant primary hemangiopericytoma cell cultures. Extracellular addition of IGF II significantly enhanced cell proliferation in a dose-dependent manner. Antisense oligodeoxynucleotides that specifically inhibit IGF II mRNA, at a concentration of 40 or 80 micrograms/ml, inhibited the growth of hemangiopericytoma cells significantly, by 40%. Simultaneous administration of antisense deoxyoligonucleotides to both IGF II and IGF I receptor inhibited tumor cell proliferation by even 80%. Our data suggest that tumor cells produce IGF II, and that this in turn stimulates their proliferation by autocrine mechanisms.

Human papillomavirus deoxyribonucleic acid testing in screening of high grade cervical intraepithelial neoplasia

Full text is available as a scanned copy of the original print version.

Immunoscintigraphy with 99Tcm-labelled monoclonal anti-CEA BW 431/26 antibodies in patients with suspected recurrent and metastatic colorectal carcinoma: two-year follow-up

The aim of this study was to evaluate immunoscintigraphy with BW 431/26 anti-CEA antibody in the follow-up of 15 patients with colorectal carcinoma. A whole-body scan followed by SPET imaging of the abdomen and pelvis was performed 4-6 and 20-24 h after the intravenous infusion of 0.6-1.0 mg of intact anti-CEA monoclonal BW 431/26 antibody labelled with 814-1110 MBq of 99Tcm. The HAMA response and serum CEA levels were determined. Immunoscintigraphic findings were verified by biopsy, radiologically and/or by 2 year follow-up. On an individual patient basis, immunoscintigraphy demonstrated an overall sensitivity of 83%, specificity of 100%, accuracy of 87%, positive predictive value of 100% and negative predictive value of 60%. Better results were achieved in the pelvic region than in the liver or in the extra-hepatic abdominal region. We evaluated 40 lesions; on an individual lesion basis, immuno-scintigraphy gave a sensitivity of 80% and an accuracy of 80%. SPET images detected significantly more lesions than whole-body planar images (P < 0.05). SPET at 20-24 h detected significantly more 'hot' lesions than at 4-6 h (P < 0.01). No correlation between CEA serum levels and immunoscintigraphy was observed (r = 0.376, P > 0.05). One of nine patients (11%) developed HAMA after immunoscintigraphy. We conclude that immunoscintigraphy with BW 431/26 antibody appears able to differentiate between tumour recurrence and scar tissue, and to evaluate liver metastases of colorectal carcinoma. Serum CEA levels appear not to influence the result of immunoscintigraphy and the HAMA response is minimal. A delayed SPET scan should be part of an immunoscintigraphic imaging protocol when 99Tcm-labelled BW 431/26 monoclonal antibody is used.

Immunocompetent cells and lymphocyte reactivity to mitogens in levamisole-treated brain tumor children

This study investigated the influence of levamisole therapy on immunocompetent cells and lymphocyte reactivity to mitogens in 25 children with brain tumor. Eleven (11/25) patients were receiving chemotherapy and immunomodulating drug levamisole 3 months after neurosurgery, during maintenance chemotherapy, 2.5 mg/kg of body weight per os, for three consecutive days every 2 weeks, for 6-12 months. The proportion of lymphocytes, proportion and number of T- and B-lymphocytes and natural killer (NK) cells, as well as lymphocyte reactivity to mitogens were significantly lower in non-levamisole-treated patients than in the healthy controls (N = 18). Therapy with levamisole significantly augments the proportion of T lymphocytes, the number of T lymphocytes, NK cells, and the lymphocyte reactivity to concanavalin A (Con A). Depression of the NK cells and the lymphocyte reactivity to mitogens were much more pronounced in those patients who developed recurrences. Levamisole shortened the period of secondary immunodeficiency in immunocompromised children with brain tumor.

Loss of heterozygosity of APC and DCC tumor suppressor genes in human sporadic colon cancer

We examined 36 cases of human sporadic colon carcinoma and corresponding normal tissue samples to evaluate loss of heterozygosity at the APC and DCC tumor suppressor genes loci using restriction fragment length polymorphism polymerase chain reaction and variable nucleotide tandem repeat analysis. Observed informativity was 83% for APC and 75% for DCC. DNA from 6 (20%) of 30 informative tumors exhibited loss of heterozygosity at the APC locus. Loss of heterozygosity at the DCC locus was observed in 7 (26%) of 27 informative tumor DNAs. Our results support the view that malignant progression is a consequence of more than one genetic change and suggest that inactivation of APC and DCC genes plays a role in a multistep process of colon tumor progression.