Quo vadis porphyrin chemistry?

This review summarizes recent developments in the area of porphyrin chemistry in the direction of biological applications. Novel synthetic methodologies are reviewed for porphyrin synthesis, porphyrin analog synthesis, stable porphyrinogens -- calixpyrroles, expanded porphyrins. Unique biological properties of those compounds are desribed with focus on photodynamic therapy (PDT) and molecular recognition properties. Special attentions given to metalloporphyrins with potential to affect heme degradation and CO formation.

[Analysis of regressive changes in the lung carcinoma lymphatic metastases following induction chemotherapy]

BACKGROUND

Prognosis of higher stages of non-small cell lung cancer (NSCLC) is very poor. Only 13% of patients in stage IIIA survive 5 years after the diagnosis determination. The purpose of neoadjuvant (inductive) therapy is to eliminate haematogenous and lymphogenous metastases and to cause a cytoreduction in the primary tumor before the resection. Especially detection of lymphogenous metastases is the main factor in the indication of the pre-operative chemotherapy, but this therapy is frequently indicated according to CT without any bioptic verification. The authors suppose such a discrepancy in radiological and histo-pathological staging to influence in a positive sense rather optimistic results of therapeutic protocols, which include the pre-operative chemotherapy.

METHODS

A biopsy of the lymph nodes was performed as a part of the staging. If the metastasis was proved, the lymph node was labeled and the patient was treated by 3 cycles of the pre-operative chemotherapy. The 57 labeled lymph nodes were removed during the subsequent lung resection and lymphadenectomy. An analysis of regressive alterations in the lymphatic metastases of lung cancer after an inductive chemotherapy and comparison with the pre-operative bioptic findings have quantificated the chance of the inductive therapy to eliminate lymphatic metastases.

RESULTS

The clinical down-staging was stated in 21 cases (36.8%), but the viable malignant cells rested in the majority 50 (87.7%) of the taken labeled lymph nodes 57 (100%) even after the neoadjuvant therapy. On the other hand, the satisfactory tumor regression changes was proven in 49 (86%) lymphatic metastases. CONCLUSIN: The results of the study may modify an indicating judgment in the therapy of locally advanced stages of lung cancer because it has brought a new view to the results of neoadjuvant therapy.

[Duplication of the terminal ileum--a case review]

Duplications of the gastorintestinal tract are fairly rare developmental anomalies. They may occur throughout the gastrointestinal tract, however, most commonly, they occur in the small intestine. They are usually diagnosed in early childhood, however, they may be asymptomatic first and cause symptoms as late as in adulthood. Symptoms of,,urgent abdominal conditions", ranging from symptoms of intestinal obstruction, perforation to symptoms of bleeding from the GIT, prevail. A rare finding of a carcinoma in the duplication has been recorded. The etiopathogenesis has not been fully understood. The treatment is surgical. The authors present a case-review of the terminal ileum duplication in a child with symptoms of intestinal obstruction, resp. invagination.

[Antibody response to Ascaris lumbricoides among the children population in the Ustí Region]

A group of 156 children aged between 10 and 12 years were screened for IgG and IgE antibodies to Ascaris lumbricoides. The study subjects were 64 children of Romany origin and 92 children from the majority population. IgG antibodies to Ascaris lumbricoides were detected in 112 (71.8%) children. No difference in the prevalence of IgG antibodies was found between Romany children and those from the majority population. As many as 34.1% of the study subjects had IgE antibodies to Ascaris lumbricoides, again with no difference between the two ethnic groups. Children with IgG antibodies to Ascaris lumbricoides had significantly higher total IgE levels compared to those who had tested IgG negative. To demonstrate induction of a non-specific IgE response was one of the study objectives. The high prevalence rates of IgG and IgE antibodies to Ascaris lumbricoides are suggestive of a high frequency of cross- and non-specific reactions. Possible effect of cross-reactivity to other antigens on the specific IgG and IgE antibody response to Ascaris lumbricoides is discussed.

[The technique of securing sentinel lymph nodes in tumors of the distal oesophagus and the stomach ]

The authors discuss the technique of identification and biopsy of sentinel lymph nodes in tumors of the upper gastrointestinal tract. They describe difficulties and problems of the technique, in which the identified sentinel lymph node is obtained mainly employing endoscopical and minimally invasive techniques.

[Reflection on contemporary options for the esophageal carcinoma treatment]

Our opinions on contemporary strategies for the oesophageal carcinoma treatment, based on our oesophageal resections results, conducted in last five years, are presented in this study.

RESULTS

From 2000 to 2004/VIII, 86 resections of the oesophagus were conducted. None of the patients exited. 18 serious complications were recorded (21%).

METHODOLOGY

Surgical treatment procedures of the oesophageal carcinoma have been significantly influenced by miniinvasive techniques. Also our team employed laparoscopy as well as thoracoscopy. This technique appears to have a positive effect on both the immediate postoperative results and the long-term results, as it makes any increase in the procedure's radicality possible, mainly at the second level. The authors discuss the procedure's radicality degree as well as its limitations

CONCLUSION

Although the oesophageal carcinoma treatment results have definitely improved, especially when lethality rates and morbidity rates are concerned, the long-term results have remained unsatisfactory, though the surgical treatment is combined with the oncological treatment (neoadjuvant, adjuvant). The radicality of the procedure itself is unlikely to have much influence on the above long-term results.

[Extent of lymphadenectomy in lung resection for carcinoma]

Dissemination of the bronchogenic carcinoma into the lung and mediastinal lymphonodes is considered one of the basic prognostic factors. Correct evaluation of the lymphonodes involvement remains the principal pre-requisite for the choice of the most appropriate procedure and makes a forecast of a particular patient's perspective possible. The preoperative diagnostics of malignant lymphadenopathy is based on a CT examination. Once enlarged lymphonodes are detected, invasive exploration is indicated--either via mediastinoscopy, eventually via thoracoscopy. The final picture of the extent of the tumor dissemination via lymphatics is provided by the final histopathological examination of the lymphonodes removed during the surgical procedure. The minimal extent of lymphadenectomy is still being discussed. Some clinics do not conduct it at all. On the other hand, there are some clinics, where the en-bloc mediastinal lymphonodes dissection remains a common procedure during all lung carcinoma surgical procedures. On the group of 226 patients operated between 1996-1999, the authors assess surgical aspects and complications of the lymphadenectomic procedure within the radical lung resection for the non-spinocellular lung carcinoma. In the subgroup of 73 patients with a confirmed malignancy of the lung lymphonodes, the authors have found no statistical difference in the five-year survival rate which would be connected to lymphadenectomy. Mediastinal lymphadenectomy, with respect to its sound diagnostic and prognostic benefits, remains a necessary part of any curative resection. It proved to improve local control of the tumor, however, it has no clear influence on the survival rate. In small peripheral tumors (T1, T2), its extent may be restricted to systematic sampling of the interlobium, lung hilus and medistinum lymphonodes. On the other hand, in case of advanced tumors after the induction therapy, no other than en-block resection procedures are suitable or even possible.

[What to expect from the neoadjuvant therapy of the oesophageal carcinoma?]

AIM

The aim of this study was to assess the neoadjuvant therapy of the oesophageal carcinoma firstly from the perspective of the immediate effect on the resection procedure itself and, secondly, from the perspective of the long-term results.

METHODOLOGY

Prior to the resection of the oesophagus, the patients were administered the neoadjuvant therapy. The patients were allocated to three groups with the following branches of the cytostatic treatment: CDDP+FU, TAX+FU a CDDP. A smaller group with a less advanced disorder was treated only surgically, with the oesophageal resection. Furthermore, the study aimed at assessing chemoresistance of the tumors according to the MTT test and at correcting the individual branches appropriately.

RESULTS

The total of 70 patients were operated from 2001 to V/2004. Out of this number, 15 oesophgeal resections without the neoadjuvant therapy were conducted. None of the patients exited, and fistules were the commonest complications.

CONCLUSION

No differences in postoperative complications were reported between the groups with or without the neodjuvant therapy. Therefore, this therapy has no positive effect on the resection results themselves. The MTT test proved to be of low significance in the neodjuvant therapy assessment. Chemoresistance can be assessed only retrospectively and, furthermore, the results are likely to be affected by a relatively high sensitivity to the neodjuvant therapy itself. The pCR rate reaches 20%. Long-term results had not been assessed due to a short follow-up period.

[Reoperations following laparoscopic fundoplication]

During an eight-year-period, 623 laparoscopic fundoplications were conducted in the Surgical Clinic in Olomouc. Out of the total number, 14 of them were reoperations and 4 reoperations were conducted on patients, primarily operated in other clinics. 9 patients were reoperated for dislocations of the rim transhiatally into the mediastinum, respectively aborally to the gastric fundus. 4 patients were operated for oesophageal constricions in the hiatus region and 2 patients for haemoperitoneum caused by haemorrhaging from a wound after the port removal. The remaining 3 patients had the reoperation indicated for a biliary reflux in the oesophageus, the rim loosening or for a non-standard primary procedure, conducted to treat the oesophageal reflux disorder in another clinic. This study discusses causes of individual complications and their treatment alternatives. The authors point-out prevention of complications based on following certain principles during the laparoscopic fundoplication procedures.

[Complications of extended lung resection procedures following the neoadjuvant therapy]

Local tumor expansion in the sense of the tumor invasion into the extrapulmonary structures, which must be removed in one step, preferably en-bloc, together with the primary tumor, is the reason for extending the lung resection procedure. Although verified lymphogenic metastasing into either unilateral, eventually into contralateral mediastinal lymphonodes (stage N2 resp. N3, according to the TNM), remains the commonest indication for the induction therapy in cases of the lung carcinoma, application of the neoadjuvant therapy in cases when extended resections may be expected, is indicated in case the tumor expands into the surrounding structures, which signifies opening of new, unnatural routes of possible lymphogenic and haematogenic dissemination, and thus, a significantly higher risk of the surgical therapy failure. During the period 1995-2002, our team conducted 15 extended lung resection procedures following the preceding induction therapy in patients suffering from the IIB-IIIB stage of the non-small cellular lung carcinoma (NSCLC). The 30-day lethality rate equalled zero. We recorded two rare complications and the postoperative morbidity was acceptable.

CONCLUSION

Exhausting staging, the best possible prediction of the tumor behaviour following the surgical procedure and minimal surgical complications remain the prerequisite for good long-term results following the extended lung resections for the lung carcinoma. Application of the neoadjuvant therapy prior to the resection procedure need not increase the risk of surgical complications and, furthermore, may positively affect the disease prognosis.

[Detection of the sentinel lymph nodes in lung carcinoma cases using patent blue and its clinical significance]

INTRODUCTION

Views on significance and the most appropriate approach to lymphadenectomy in the non-small-cell lung carcinoma cases, have not been consistent. The method of the sentinel lymphonode identification and biopsy, which has been verified for other tumor types, may become a promising alternative or, at least, a supplement to currently applied procedures in cases of the lung carcinoma.

STUDY GROUP AND RESULTS

This prospective, non-randomized study was conducted in the Faculty Hospital in Olomouc between the years 2000-2003. The sentinel lymphonode identification was conducted in the group of 48 patients suffering from the non-small cell lung carcinoma, using the patent blue lymphatic mapping method. The sentinel lymphonode was identified in 40 patients (83.3%), a false negativity of the sentinel lymphonode was detected in 3 cases (7.5%).

CONCLUSION

The study proved the clinical benefit of the sentinel lymphonode identification and biopsy method in cases of the non-small cell lung carcinoma using the patent blue dye. Under the circumstance of certain experience with the technology, the reliability of the detection approaches that of the radionuclide sentinel lymphonode detection method. However, the clinical significance of the above method must be further tested on larger patient groups.

[Atypical portocaval anastomosis for hemorrhage in portal hypertension]

The success of endoscopy in treating esophageal varices and the later introduction of liver transplantation into the algorithm of therapy for liver failure shifted surgery of portal hypertension out of sight of hepatologists and surgeons. This decline from surgical treatment was further confirmed by introduction of TIPS into clinical practice. It is completely out of question that only liver transplantation is the causal solution of decompensated liver disease and a series of reliable and less invasive methods may be selected for acute treatment of bleeding from varices. However, even at the present time the portal-systemic shunt may be used in its own indication in repeatedly bleeding patients with a good liver capacity, where it can play a role by bridging the time to liver transplantation in a way similar to TIPS or even to provide a final solution, which makes it possible to live the life expectancy in adequate comfort without the risk of bleeding complications. However, it is not always possible to place a surgical shunt on some of the main branches of the portal vein. In such cases, devascularization is often successfully applied. Atypical shunts represent an exceptional alternative, because side feeder veins of the portal vein are rarely of sufficient caliber for placing a hemodynamically significant shunt. The authors describe two cases, in which stubborn anemia-causing bleeding events in portal hypertension were treated with left-side epiploic-renal shunt or anastomosis between the mesenteric and left-side iliac vein.

[Solid papillary neoplasia of the pancreas--case report]

Solid papillary neoplasia of the pancreas is a rare tumour that occurs most commonly in young women. This tumour has low malignant potential and favourable prognosis following surgical resection. Therefore it is mandatory to distinguish this tumour from other types of pancreatic tumours. The paper reports the case of a 31-year-old woman with a large solid papillary neoplasia of the head of pancreas where successful pancreatoduodenectomy was performed.

Laparoscopic transhiatal resection of epiphrenic diverticulum

Our experience with videolaparoscopic operations for hiatus hernia and achalasia, which have almost replaced classical procedures, enabled us to use the same technique for other interventions in the distal third of the thoracic esophagus. Thus, we were able to treat epiphrenic diverticulum using a minimally invasive approach. We report our experience with videolaparoscopic diverticulum resection. The procedure was performed in three patients, all of them elderly men with ventilation limitation and a history of a chest intervention. The procedure included myotomy and an antireflux procedure. No significant complications occurred during the operations or postoperative periods; a minor leak that was successfully managed conservatively occurred in one patient. We conclude that videolaparoscopy could be a possible alternative to the standard classical left-side thoracotomy approach for patients in whom a classical operation is not feasible.

Monomer and polymer quinoxaline derivatives for cationic recognition

Monomeric and polymeric 5-nitroquinoxaline derivatives disubstituted in the 2 and 3 positions with 2-pyrrolyl (A), 2-furyl (B) and 2-thienyl (C) groups were prepared and characterized. The substituted 5-nitroquinoxalines were used as active components in poly(vinyl chloride)-membrane and electropolymerized electrodes that were then tested as possible sensors for various cationic species. In contrast to the difurylnitroquinoxaline-based systems, the monomeric and polymeric dipyrrolyl- and dithienylquinoxaline electrodes displayed a good selectivity for Ag(+) ions, providing a near-Nernstian response in the 10(-5) to 10(-2) mol L(-1) concentration range. The similar potentiometric behavior displayed by the monomeric and polymeric forms of systems A and C supports the contention that the main binding modes displayed by the monomeric forms are retained in the corresponding polymeric structures.

[Importance of neoadjuvant chemotherapy in the treatment of advanced bronchogenic carcinoma]

BACKGROUND

The basic task of induction (neo-adjuvant) therapy is elimination of occult micrometastatic dissemination found in some cases already in localized stages of non-small cell pulmonary cancer (stage I-IIIA NSCLC). An equally important effect is also cytoreduction in primary tumours which have before the local intervention an intact vascular supply. A difficult problem remains the correct selection of patients who from the long-term aspect may profit from such a procedure.

MATERIAL AND METHODS

The authors evaluated perspectively aspects of oncological treatment and circumstances of surgical intervention after induction chemotherapy in 81 and 87 patients resp. in stage IIIA NSCLC evaluated before initiated neo-adjuvant chemotherapy.

RESULTS

Complete remission was recorded in 4.9%, partial remission in 50.6%, stabilized disease in 23.5% and progression in 21% patients. Down-staging was recorded in 26%, 70.3% patients were indicated for surgery. In the group of 87 patients operated after induction therapy pneumonectomies predominated--41 (46%), only one operated patient died within 30 days after surgery (1.1%), complications were neither frequent nor serious. The median of survival after radical resection is 26 months.

CONCLUSIONS

Neo-adjuvant chemotherapy by modern cytostatics is usually well tolerated and creates satisfactory conditions for successful complete resection. The operation proper may be more difficult but need not be associated with serious complications. By this treatment it is probably possible to influence long-term results not only in stage IIIA but to reduce also the risk of a later more remote metastatic dissemination in some patients operated in lower stages of lung cancer. Our present aim is to test parameters which will be able to predict possible failure of induction therapy, and seek factors predicting risk behaviour of the tumour also in lower stages (stage I and II TNM classification).

[Detection of Helicobacter pylori in the saliva of patients with recurrent aphthous stomatitis]

BACKGROUND

Helicobacter pylori participates significantly on the pathogeny of chronic gastritis, duodenal and gastric ulcer, carcinoma and lymphoma of the stomach. There are some more diseases requiring attention--for example cardiovascular, dermatologic, and autoimmune.

METHODS AND RESULTS

Helicobacter pylori was detected in saliva and faeces of 28 persons by the Premier platinum HpSA diagnostic set. Levels of IgA and IgG antibodies were determined by EIA and Western Blott methods. Parameters of salivary immunity were investigated as well. Levels of IgG, SIgA, IgM, lysozyme and albumin were determined. Recommended therapy of Helicobacter infection led to an evident clinical improvement and descent of the documented Helicobacter pylori antigen.

CONCLUSIONS

Helicobacter pylori infection can probably participate in some cases of relapsing aphtous stomatitis.

[Histologic findings in protocol biopsies of transplanted kidneys]

Fourty eight patients with cadaveric kidney allografts treated by cyclosporin A (CSA) or tacrolimus (FK506) underwent protocol graft biopsies at 1, 3 and 12 months after transplantation, and 110 biopsy specimens were obtained. Histologic diagnosis was made according to the Banff scheme. The main cause of the graft instability at 1 and 3 months was acute clinical rejection, these biopsies showed all known histological patterns of tubulointersticial and vascular rejection. Acute tubular nephropathy was found in 13% and borderline changes or nephrotoxicity in 8.7% of instable grafts. Specifically, we focused on the occurRence of subclinical rejection and toxic reactions in stable renal allografts. Of these, 36.1% showed histological patterns of acute tubulointersticial and vascular rejection. The Banff score of subclinical rejection was significantly lower than in clinically apparent rejection. CSA and tacrolimus nephrotoxicity were seen in 14.2%, 19.5% and 27.2% of specimens at 1, 3 and 12 months, respectively. In over one half of the identified cases of nephrotoxicity neither increased level of immunosuppression nor features of allograft dysfunction were found. At 12 months, 45.5% of specimens showed mild chronic transplant nephropathy and 18.1% moderate chronic transplant nephropathy. Normal morphology was found in 36.4% of biopsies. We found a high prevalence of subclinical rejection and nephrotoxicity in the studied cohort. We conclude that protocol biopsy is a reliable method in the diagnosis of clinically silent, as well as clinically apparent, disorders of the transplanted kidney.

[Gene therapy of liver tumors: results of the first clinical studies]

Only a small percentage of primary and secondary liver tumours is suitable for surgical resection. Gene therapy represents a novel strategy that seems to be effective both, in vitro and in vivo. The use of tumour suppressor gene p53 therapy, suicide gene therapy, immune gene therapy and therapy with replication-competent oncolytic adenoviruses in liver tumours already entered the first clinical trials. In patients with hepatocellular carcinoma, the first clinical trials in phase I and II showed good tolerance and low toxicity to gene therapy. However, the clinical benefit for the patients treated either with wild type p53 or E1B deleted adenoviruses were marginal.

[Role of modern absorbable suture materials in decreasing the occurrence of early complications after laparotomy]

Uncomplicated healing of surgical wounds is one of the most important factors which contribute to the success of operations. In particular dehiscence of laparotomy is an important complication associated with considerable morbidity and lethality. A number of factors which contribute to the healing of the surgical wound at the time of operation cannot be influenced, it is however possible to influence the technique of wound closure and the material used. The authors compare in their study early postoperative and long-term results of closure of laparotomy in three groups of patients where for closure of laparatomy PDSII loop suture was used, continuous suture with Vicryl and classical suture by individual silone stitches. The investigation revealed a significantly lower incidence of early postoperative complications in patients where modern absorbable materials were used, in particular early infections. The incidence of dehiscence of laparotomy or hernia in the scar did not differ significantly although in the group with absorbable materials, contrary to the group with silone, there was no dehiscence of laparotomy without an infectious complication of wound healing.

CONCLUSION

Empirical experience and the conclusions of some major investigations indicate that the best method of closure of laparotomy is continuous suture using absorbable material.

[Subclinical rejection of kidney transplants and the possibilities of its diagnosis]

RESOURCE

The subclinical rejection is defined as finding of histological signs of rejection on well functioning grafts. Its diagnostic domain remains protocol biopsy. The diagnostic value of ultrasound scaning in subclinical rejection has not been studied yet.

AIM

The aim of our study was to detect the incidence of subclinical rejection in protocol biopsies in the first three months after kidney transplantation and to find out the ultrasound correlation to histological picture of subclinical rejection with special accent on ultrasound signs of parenchymal oedema, quantity and quality of perfusion emphasising their changes in process of time.

METHODS

Sixty six protocol graft biopsies were performed on 36 recipients of cadaveric renal transplants in Transplant Centrum Olomouc between July 1999 and September 2000. The biopsies were carried out 21 +/- 2 days and 90 +/- 5 days after transplantation. Subclinical rejection was defined as t2 i2 v0 (IA) rejection infiltrate by Banff 97 histological classification at the same time with serum creatinine in normal range and ultrasound signs of parenchymal oedema.

RESULTS

In the group of subclinical rejection the ultrasound findings of graft parenchymal oedema correlated with 81% sensitivity and 90 % specificity with histological diagnosis. The duplex picture of parenchymal hyperaemia blush - had 100 % specificity but low sensitivity. The resistive indices were in the wide range 0,61 - 0,80 without diagnostic value.

CONCLUSION

The high sensitivity and specificity of ultrasound prospective follow up was found in the subclinical rejection diagnosis. Parenchymal hyperaemia indicated high specificity but low sensitivity in evaluation of subclinical rejection. No benefit of resistive indices was found. Larger sample of patients has to be established to gain more exact review anyway.

Noncovalent interactions of peptides with porphyrins in aqueous solution: conformational study using vibrational CD spectroscopy

Noncovalent interactions of poly(L-lysine) (PL), oligopeptides L-lysyl-L-alanyl-L-alanine and (L-lysyl-L-alanyl-L-alanine)(2) with meso-tetrakis(4-sulfonatophenyl)porphine (TPPS), and poly(L-glutamic acid) (PLGA) with meso-tetrakis(1-methyl-4-pyridyl)porphine tetra-p-tosylate (TMPyP) in aqueous solutions have been studied using combination of spectroscopic methods: Vibrational circular dichroism (VCD) spectroscopy in the mid-infrared region provides a direct information on conformational changes of the polypeptides and oligopeptides caused by interactions with porphyrins; ultraviolet-visible absorption, fluorescence, and electronic circular dichroism (ECD) reveal the aggregation characterization of the porphyrin part of the complexes. Interactions of TPPS with tripeptide, hexapeptide, and PL containing about ten amino acid residues in the molecular chain are accompanied with the changes of VCD patterns in the amide I' region. In these cases, the conformation of the oligopeptide part of complexes is obviously influenced by interactions with TPPS and partial changes of random coil structure are observed in VCD. When PL was composed of the hundreds of lysine residues, just a weak intensity decrease was detected and the shape of VCD spectrum typical for the random coil structure was preserved. As follows from the uv-vis absorption and fluorescence spectra, porphyrin molecules are attached to peptides by electrostatic interaction as a monomer or dimer and interaction between porphyrin and peptide depends on the polypeptide chain length. For the PLGA-TMPyP system with PLGA containing from tens to hundreds of glutamic acid residues in the chain, the VCD spectra were unchanged when TMPyP was presented in the aqueous solution of PLGA and random coil conformation of PLGA-TMPyP aggregates was preserved.