[Monitoring the effectiveness of surgical treatment of malignant pleural effusions]

BACKGROUNDS

Recurrent pleural effusion occured in 10% of cancer patients. Repeated thoracocentesis or drainage may be complicated by pneumothorax, haemothorax or pleural cavity infection. Thoracoscopic talc poudrage is one of the most effective pleurodesis technique in patients with malignant pleural effusions. The effectiveness of such pleurodesis is reaching the 70 to 90%. This surgical approach also allows to take a biopsy for histological verification of the process. An effort to predict the success rate of chemical pleurodesis on the basis of the body's general inflammatory reaction rate, which is determined by the dynamics of values of humoral and cellular inflammatory parameters in both serum and in pleural effusion.

PATIENTS

In the period 6/2008-12/2009 we applied biotalcum to 14 patients with malignant pleural effusions. The group of patients consisted of 10 male patients and 4 female patients of average age 71 years. Indication to include patients in the group was a second or further thoracic puncture, shortening of the interval between interventions, estimated time of survival > 3 months and the possibility of operation under selective pulmonary ventilation.

METHOD

We performed the collection of pleural effusion and blood serum at 12-hour intervals. The first collection was performed preoperatively before biotalcum application, and then during the time of losses from thoracic drainage bigger than 150 ml in 24 hours. The duration of thoracic drainage was 4 days +/- 1 day. The success of the treatment was observed by ultrasound scan before drainage removal; during the first three months always at intervals of 1 month and then after 3 and 6 months, depending on the progression of a disease.

RESULTS

No reccurence occured when the P-CRP (pleural) and S-CRP (serum) ratio exceeded 60% during the first 48 hours after pleurodesis. On the other hand, when the ratio fall bellow 30-35%, the effusion relapsed frequently.

CONCLUSION

The P-CRP/S-CRP ratio as a promising marker of talc pleurodesis effectiveness and monitoring both P-CRP and S-CRP levels is inexpensive and acceptable method for clinical practice. The pleural effusion caused by malignant mesothelioma appeares to be resistant to talc pleurodesis.

Biological prognostic markers in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is the most frequent leukemic disease of adults in the Western world. It is remarkable by an extraordinary heterogeneity of clinical course with overall survival ranging from several months to more than 15 years. Classical staging sytems by Rai and Binet, while readily available and useful for initial assessment of prognosis, are not able to determine individual patient's ongoing clinical course of CLL at the time of diagnosis, especially in early stages. Therefore, newer biological prognostic parameters are currently being clinically evaluated. Mutational status of variable region of immunoglobulin heavy chain genes (IgVH), cytogenetic aberrations, and both intracellular ZAP-70 and surface CD38 expression are recognized as parameters with established prognostic value. Molecules regulating the process of angiogenesis are also considered as promising markers. The purpose of this review is to summarize in detail the specific role of these prognostic factors in chronic lymphocytic leukemia.

RANK/RANKL expression is induced by cardiac surgical operation

BACKGROUND

Cardiac surgery provokes a systemic inflammatory response in any patient. This complex body reaction involves also RANK/RANKL molecules which have been recently identified as principal regulators of bone metabolism.

AIMS

To follow the changes in the expression of RANK/RANKL molecules on innate immune cells of cardiac surgical patients.

PATIENTS AND METHODS

Twenty-six patients undergoing cardiac surgical were assigned to undergo coronary artery bypass grafting using either cardiopulmonary bypass ("on-pump") or modified "miniinvasive on-pump". The expression of RANK/RANKL was performed by flow cytometry.

RESULTS

Significantly increased expression of RANK on monocytes of "miniinvasive on-pump" patients was found at the 1st, the 3nd, and 7th postoperative days. The similar pattern was found also for monocyte RANKL expression. In addition, RANKL expression was significantly increased at the 3rd postoperative day in "on-pump" patient. No significant differences between "miniinvasive on-pump" and "on-pump" cardiac surgical patients were found.

CONCLUSION

The expression of both RANK and RANKL molecules is significantly enhanced on monocytes of "miniinvasive on-pump" cardiac surgical patients.

Scavenger receptor CD163 and its biological functions

CD163 is a member of scavenger receptor super family class B of the first subgroup. It is mapped to the region p13 on chromosome 12. Five different isoforms of CD163 have been described, which differ in the structure of their cytoplasmic domains and putative phosporylation sites. This scavenger receptor is selectively expressed on cells of monocytes and macrophages lineage exclusively. CD163 immunological function is essentially homeostatic. It also has other functions because participates in adhesion to endothelial cells, in tolerance induction and tissues regeneration. Other very important function of CD163 is the clearance of hemoglobin in its cell-free form and participation in anti-inflammation in its soluble form, exhibiting cytokine-like functions. We review the biological functions of CD163 which have been discovered until now. It seems apparent from this review that CD163 scavenger receptor can be used as biomarker in different diseases and as a valuable diagnostic parameter for prognosis of many diseases especially inflammatory disorders and sepsis.

The expression of CD38 ADP-ribosyl cyclase ectoenzyme in immune cells of cardiac surgical patients

BACKGROUND

This study was aimed at following the changes in the expression of CD38 ADP-ribosyl cyclase ectoenzyme on peripheral blood immune cells of patients undergoing cardiac surgical operations.

PATIENTS AND METHODS

The expression of CD38 on lymphoid and myeloid cells was determined by immunofluorescence and flow cytometry in forty cardiac surgical patients assigned to surgery either using ("on-pump", n=20) or without the use ("off-pump", n=20) of cardiopulmonary bypass.

RESULTS

There was a very rapid upregulation of CD38 expression in "on-pump" patients, becoming significant at declamping of aorta (p<0.01) for myeloid cells and at the weaning from CPB (p<0.001) for lymphocytes. The increased expression of CD38 on lymphocytes in "off-pump" patients was prolonged for the entire observation period. However, significant differences in the expression of CD38 between "on-pump" and "off-pump" patients were not found either in lymphoid or myeloid cells.

CONCLUSION

CD38 expression in immune cells of cardiac surgical patients is upregulated early during surgery, providing additional activation stimuli to the cell substrate of the inflammatory response induced by cardiac surgery.

The effect of cardiac surgery on peripheral blood lymphocyte populations

BACKGROUND

Cardiac surgery using cardiopulmonary bypass (CPB) is associated with some adverse postoperative complications caused by an altered immune response. An alternative approach to cardiac surgery, operating without the use of CPB (i.e. off-pump surgery), seems to display less adverse impacts on the immune response.

PATIENTS AND METHODS

Peripheral blood lymphocytes in 40 patients undergoing cardiac surgery either with CPB ("on-pump") or without CPB ("off-pump") were followed using flow cytometry. The samples of peripheral blood were taken at five intervals: preoperatively, after termination of the surgery, on the first, on the third and on the seventh postoperative day, respectively.

RESULTS

The most substantial changes appeared on the first postoperative day in both subgroups of patients. While the percentage of both total T cells and CD4+ T cells were decreased, the percentage of HLA-DR+ activated lymphocytes was increased. These changes were more profound in the "on-pump" subgroup compared to the "off-pump" subgroup.

CONCLUSION

Our results may suggest that the "off-pump" surgical approach reveals less adverse impact on adaptive immune responses.

[Cardiac surgery operations and their influence on serum level of antiinflammatory cytokine interleukin-10]

BACKGROUND

Cardiac surgical operation is followed by the development of inflammatory reaction. This reaction is regulated in many ways including the production of antiinflammatory cytokines such as IL-10 to avoid potentially harmful effects of inflammation.

METHODS AND RESULTS

We compared serum levels of cytokines IL-10, IL-6, and IL-13 in the group of patients undergoing cardiac surgical operation using either cardiopulmonary bypass (CPB, n=17) or surged on the beating heart (n=17). We found significant elevation in the serum level of IL-10 during surgery with the peak immediately after finishing surgery in CPB patients and at the first postoperative day in non-CPB patients, respectively. There is statistically significantly higher level of IL-10 in CPB patients in comparison with non-CPB patients at the end of surgery. Serum level of IL-6 is elevated in both groups during surgery reaching maximum immediately after surgery in CPB patients and at the first postoperative day in patients without CPB, respectively. The serum levels of IL-13 are only nonsignificantly changed during operation and in postoperative period in both groups.

CONCLUSIONS

The intensity of inflammatory response in CPB patients which is enhanced by massive contact activation of blood and extensive ischemia-reperfusion injury is regulated by the production of antiiflammatory IL- 10 cytokine.

[Multidrug resistance markers monitoring in acute myeloid leukemia cells]

BACKGROUND

P-gp, MRP, LRP, Bcl-2, and Bax proteins play an important role in the multidrug resistance of leukemic cells. P-gp, MRP, and LRP proteins decrease the intracellular drug concentration, Bcl-2 and Bax proteins influence the apoptosis process. The overexpression of some of these proteins is associated with poor prognosis of leukemia. The aim of this study was to find the relationship between some multidrug resistance markers and some clinical and laboratory parameters. We compare also P-gp expression between acute myeloid leukemia (AML) FAB subgroups M0-M6.

METHODS AND RESULTS

With use of flow cytometry we measured the expression of P-gp, MRP, LRP, Bcl-2, and Bax proteins in acute myeloid leukemia patients cells. The study proved the association between blast percentage and P-gp protein expression (p=0.015) and the association between blast percentage and Bcl-2 protein expression (p=0.041). It was also shown the tendency of the LRP protein expression to associate with higher age of patients (p=0.062). Another correlation between MRP and Bax expression (p=0.006), as well as between LRP and Bax expression was found (p=0.034). In AML M0 FAB subgroup of patients the trend to higher P-gp protein expression was observed.

CONCLUSIONS

The laboratory methodology to multidrug resistance markers detection was introduced. Some relations between multidrug resistance markers playing role in acute myeloid leukemia patients prognosis were suggested.

[Cytoimmunofluorometry in the diagnosis of MALT lymphoma of the gastrointestinal tract]

MALT lymphoma is raised from lymphoid cells of mucosa associated lymphoid tissues in a long-term, multistep process of the accumulation of genomic damage very often under the influence of chronic (e.g. Helicobacter pylori) infection. Cytoimmunofluorometric analysis of cell suspensions obtained from mechanically disintegrated bioptic samples of gut mucosa is a very useful approach to detect the presence of MALT lymphoma cells. MALT lymphoma cells are in a great majority of B cell origin. Malignant cells are characterized by the typical characteristic SS parameter, strong expression of CD20 and CD79b molecules, and by the absence of CD5 and CD23 molecules. The ultimate evidence of clonality is immunoglobulin light chains either kappa or lambda expression determination.

[Multidrug resistance of leukemia cells to cytostatics--the functional fluorescent dye efflux assay evaluated by flow cytometry]

The functional fluorescent dye efflux assays are used in the study of the multidrug resistance of the malignant cells to the cytotoxic drugs which is caused by the overexpression of P-glycoprotein (P-gp) or another membrane transport system--a multidrug resistance related protein (MRP). P-glycoprotein and a multidrug resistance related protein are involved in the efflux of cytotoxic drugs out of the cell and are responsible for the resistance. Fluorescent dye efflux mediated by these proteins could be evaluated by the flow cytometry. This test seems to be an optimal approach to study the multidrug resistance. With help of the specific inhibitors such as verapamil and cyclosporine A, the functional capacity of these proteins and the possibility to overcome the multiresistant phenotype can be revealed. The cell line K562 with transfected P-glycoprotein gene serves as a model system for the studying of the transport function with the use of the fluorescent substrates and P-glycoprotein inhibitors.