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PubMed1997

[Analysis of cost minimization of epidural anesthesia compared with general anesthesia in oncologic coloproctologic surgery].

BACKGROUND: Combined general and epidural anaesthesia in abdominal surgery has shown, both, protective and no effect on final outcome. The aim of this study was to evaluate combined epidural and general anesthesia. METHODS: One hundred and eighty four patients, diagnosed of neoplastic process, in whom an elective procedure of coloproctologic resection and reconstruction was scheduled during the period between January-1993 and December 1994, were studied. In thirty consecutive patients a combined general-epidural anaesthesia (EA) was performed. These patients were compared to thirty general anaesthesia patients (GA), selected randomly from the same period. RESULTS: Both groups were comparable for demographic characteristics and for the type and duration of the surgical procedure. Red Blood Cells units transfused were 1.7 +/- 3 in the EA group and 1.4 +/- 1.9 in the GA group. After the operation, most of patients went to SICU. The length of the hospital stay was 13 +/- 6 days for GA group, while for EA group was .13 +/- 5. The hospital mortality for all operated patients (N = 184) was 1.1%, which were directly related to failure of surgical anastomosis. The need for mechanical ventilation and pulmonary complications were similar in both groups. When analyzing costs, EA group represented a value (pesetas) of 433,501 +/- 183,337 for GA group and 437,735 +/- 149,572 for EA group. CONCLUSIONS: As shown, in the actual context, we conclude that the anaesthetic technique did not have any influence on outcome or on cost.

Adolescent↗
PubMed1997

[Cardiac tamponade as first clinical manifestation of small cell carcinoma].

A 69 year old man was diagnosed of cardiac tamponade. At surgery a large hemopericardias was evacuated, cardiac and pericardial metastasis of an oat cell carcinoma was demonstrated. The patient died 4 weeks later. A review of the literature is done about patients with cardiac tamponade as the first manifestation of a neoplastic process.

Carcinoma, Small Cell↗
PubMedDate not supplied

[Endoscopic ventriculostomy in the treatment of obstructive forms of hydrocephalus].

Third ventriculostomy creating a pathway for the CSF from the third ventricle to the interpeduncular cistern is a rational and sound alternative to the implantation of the shunting system, including Torkildsen shunts in managing obstructive hydrocephalus. Twenty four patients with hydrocephalus aged from 6 to 46 (mean 21 year) were operated. In 20 patients the occlusion was caused by small tumors in the aqueduct area, in 4 cases the occlusion was due to non-neoplastic process. In the majority of cases (19 patients) third ventriculostomy was the first operation for hydrocephalus. A rigid ventriculoscope (K. Storz, Germany) with an external diameter of 6 mm was used in all procedures. In 23 patients a rapid clinical improvement was observed along with resolution of intracranial hypertension. Median follow-up of 7 months duration was possible in 18 cases. 16 patients remain stable with no signs of hydrocephalus. Control MRI studies showed patent ventriculostomy. 5 patients after an endoscopic procedure were treated with irradiation for tumors. In 2 patients the opening in the ventricular floor fused and became nonfunctional. It happened 4 months after fenestration followed by surgical removal of tumors of the pineal region which caused occlusion. Complications were observed in 2 cases. In one patient ventriculitis developed shortly after the procedure and resolved completely by the end of the second postoperative week. Another patient was noted to have signs of transitory moderate diabetes insipidus.

Adolescent↗
PubMed1997

The influence of melatonin on metabolic changes in female rats induced by continuous irradiation and/or administration of 7,12-dimethylbenz/a/anthracene.

Metabolic profile is an important biological marker of neoplastic processes not only in the tumor itself but also in the host organism. The neurohormone melatonin has been implicated in experiments as an oncostatic agent. Female Wistar:Han SPF rats (Velaz, Prague, Czech Republic) were irradiated continuously for 15 days using a daily gamma rays dose of 96 mGy. At the end of exposure one group of rats was administered 5 mg/kg b.w. of dimethylbenz/a/anthracene (DMBA) intragastrically. During the period of exposure to ionizing radiation a part of the animals was supplied with melatonin (M) at a concentration of 20 microliters/ml in drinking water. Selected parameters of lipid and carbohydrate metabolisms and levels of selected hormones were determined 2, 30 and 100 days post-irradiation. The irradiation itself caused only small changes in tissue lipids. The application of a single low dose (subthreshold from the point of view of induction of mammary tumors) of DMBA caused more pronounced changes in nonirradiated animals; of the changes observed an increase in lipids in the liver, triacylglycerols (TG) in the thymus and decrease in myocardial glycogen predominated. The intake (by drinking) of exogenous M prevented the biochemical pattern of fatty liver in animals administered DMBA in both groups, irradiated and nonirradiated. A prolonged effect of exogenous M, demonstrated by prevention of increase in TG in the thymus and of irradiated animals caused by administration of DMBA, was observed. The mechanism of metabolic effect of M is not known. Additional experiments are needed to explain the relationship between the beneficial effect of M on metabolic changes and its presumable oncostatic effect in rats.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1997

[Retrospective study on palliative treatment of pancreatic cancer].

A retrospective analysis included 119 patients with inoperable pancreatic cancer confirmed in histological examination. This group of patients was treated in Memorial Cancer Institute Cracow Branch between 1950 and 1993. The study revealed that a palliative operation (gastroduodenostomy, cholangioenterostomy or cholangiogastrostomy) was the factor of great influence on the time of survival. The average survival in operated versus not operated patients was 7.5 months and 4.0 months, respectively. Another factor exerting influence on the survival appeared to be the progression of the neoplastic process. The average survival in case of locally advanced versus disseminated disease was 6.9 and 2.3 months, respectively. Although the survival in the group of patients who underwent chemotherapy was longer, the significance of this method of treatment can not be estimated as the group was not numerous enough. The time from the beginning of symptoms and from the first physical examination to establishing diagnosis has prolonged in the last decade.

Antineoplastic Agents↗
PubMedDate not supplied

[Dendritic antigen-presenting cells of the distal section of the female reproductive tract in normal, experimental and in pathological conditions].

Female lower genital tract (the vulva, vagina and uterine cervix) contains a system of dendritic antigen-presenting cells (APCs) which are the main elements of the afferent limb of its local immune system. These cells are found both in mucosal epithelium and lamina propria and possess specific ultrastructural, cytochemical, immunocytochemical and functional properties. Most numerous and well-studied populations of APCs in female lower genital tract are Langerhans cells which are highly sensitive to hormones and noxious factors. This review summarizes recent data on distribution, morphological and functional characteristics of dendritic APCs in female lower genital tract under normal and experimental conditions and in some pathological states (viral infections, preneoplastic and neoplastic processes).

Antigen-Presenting Cells↗
PubMed1998

Quantitation of DNA from exfoliated colonocytes isolated from human stool surface as a novel noninvasive screening test for colorectal cancer.

The only widely used screening test for early detection of colorectal cancer, the fecal occult blood test, lacks both sensitivity and specificity because it relies upon incidental bleeding rather than the neoplastic process. With the purpose of developing a new noninvasive diagnostic approach, we quantified DNA extracted from cells isolated from the surface of human stools by a novel procedure. Stools collected from 28 healthy individuals, 17 colorectal cancer patients, and 11 colorectal polyp patients were analyzed. A stool DNA index (SDNAI), expressed as DNA amount in nanograms per gram of stool, had a remarkable 4.5-fold difference in mean values between colorectal cancer patients and healthy people of comparable age. SDNAI was 2133 +/- 407 in the cancer group versus 469 +/- 65 in healthy people of the older (> 50 years) age group (P = 0.0005). The difference was independent of tumor location and size. If 700 ng of DNA/g of stool was taken as a cutoff SDNAI value in discrimination between older healthy people and cancer patients, sensitivity and specificity values reached 1.00 and 0.81, respectively. Age dependence of SDNAI was demonstrated by substantially lower SDNAI values (mean, 227 +/- 41) in younger healthy individuals. Polyp patients sometimes displayed elevated SDNAI values, but considerable variation was observed (mean, 1215 +/- 548). These preliminary findings indicate that SDNAI provides a novel, simple, and powerful noninvasive test for colorectal cancer early detection and screening. The fundamental advantage of the SDNAI is that it directly characterizes colonic epithelium involved in carcinogenesis.

Adult↗
PubMed1997

[The evaluation of certain psychological indices concerning cognitive and emotional behaviors in patients after radical neck dissection].

Every disease and especially neoplasmatic disease is a source of deep mental experiences. The aim of this study was the establishment of some psychological behavioural parameters in 55 patients who underwent radical neck dissection and in 32 patients operated for other, non-neoplasmatic laryngologic diseases. In order to evaluate psychological state of the patients the following of States and Personality Traits (TISCO), 2. Feeling of Safety Question Sheet (KPB), 3. Profile of Mood States (POMS), 4. Scale of Hopelessness (HS-8). It was stated, that patients after radical neck dissection have deviations concerning indexes of cognitive and emotional behaviour and that there are differences between patients operated as the reason of neoplastic processes and other patients. These differences appear also among persons examined in the period shorter than 1 year from their surgery as opposed to patients operated earlier than 1 year before examinations. The fact of laryngectomy did not appear to have significant influence upon most of the evaluated indexes of cognitive and emotional behaviours.

Adult↗
PubMed1997

[p53 mutation and chemoresistance in oral-maxillofacial squamous cell carcinoma. Role of p53 in the cell cycle control and in the modulating action of chemotherapeutic agents].

p53 is a "tumor suppressor gene" with a basic function in the cellular cycle control and subsequently in the induction of the neoplastic process. p53 found changed in the majority of malignant human tumors. In the oral and maxillofacial cancers p53 mutations varies from 4% to 60% of the cases. Researches in vitro in tumors of the colon-rectum, breast, lung, ovary, testicle, bladder and in leukaemia, show a correlation between p53 overexpression (mutation) and resistance to the anti-tumor agents. The functional connection between the p53 and the chemotherapic drugs action which cause a direct DNA damage, is the apoptosis, a physiologic mechanism activated by p53 for regulating cell growth but also indispensable for the cytotoxic effects (apoptosis is an irreversible process culminating in cell death). Loss of the p53 activity (mutation) in the tumoral cells determines non-activation of the apoptosis and the drug resistance. These results have led to early clinical applications. In the breast cancers the p53 is already utilized as chemoresistance marker, directing the therapy, if changed to alternative drugs (Taxolo) which have a p53-independent action. Even into cell lung cancers a retroviral vector containing the wild-type p53 gene was produced to mediate transfer of wild-type p53, noting tumor regression. In oral and maxillofacial tumors surgery is elective. It is emphasized that, in advanced cancers, it is included in multimode protocols where the neoadjuvant chemotherapy has an important clinical function, with precise indications. The possibility to determine previously the p53 "status" in the cancer cells by genetic study, may give a specific factor of screening, indicative of the tumor chemoresponse, together with other well-known prognostic factors, with advantage for the therapeutic programming and especially for the known surgical treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Inflammatory fibrosarcoma: update, reappraisal, and perspective on its place in the spectrum of inflammatory myofibroblastic tumors.

Inflammatory fibrosarcoma (commonly referred to as inflammatory myofibroblastic tumor) has become increasingly recognized as part of a spectrum of inflammatory myofibroblastic proliferations. It is a potentially locally aggressive myofibroblastic tumor that occurs predominantly in the mesentery of children and young adults. No reliable morphological parameters have been identified that predict prognosis. We evaluated the ultrastructural and immunophenotypic features of 16 cases of inflammatory fibrosarcoma and studied Ki67 (MIB1), PCNA, bcl-2, and p53 in an effort to identify prognostic markers. p53 was not detected immunohistochemically in any case. None of the markers were found to correlate with local recurrences, metastases, or tumor deaths. Low proliferative activity (Ki67 < 10%) was seen in all cases. A characteristic immunophenotype was reconfirmed in which lesional myofibroblasts stained for vimentin, alpha-smooth muscle actin, cytokeratins, and rarely desmin. Ultrastructural studies of seven cases confirmed the presence of a fibroblastic-myofibroblastic spectrum. Because inflammatory myofibroblastic tumor-inflammatory fibrosarcoma is associated with systemic symptoms, polymerase chain reaction studies for Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were performed in 12 cases. Evaluable results in nine cases did not show evidence of either virus. The results of this study indicate that inflammatory fibrosarcoma has a low proliferative activity, which is in keeping with the impression that this is a low-grade sarcoma; that myofibroblasts can participate in true neoplasia; and that EBV and CMV do not play a role in the pathogenesis of inflammatory fibrosarcoma. The variable phenotype of the myofibroblast and its role in reactive and neoplastic processes are discussed. A perspective on the position of inflammatory fibrosarcoma in the spectrum of inflammatory myofibroblastic tumors is also given in light of the current study and the literature.

Adolescent↗
PubMed1998

[An unusual case of chondrosarcoma in a 5-year old boy].

A case of chondrosarcoma in 5 years old boy is presented. This type of neoplasm is extremely rare in this age group usually affecting patients in their forties and fifties. The tumor was located in the acetabular part of the ilium, ischial bone and the capsule what, again, is very rare, especially in children. Radiographs were atypical; there were no cloudy calcifications characteristic for malignant chondral tumors. The boy spent 2.5 years in several hospitals with various diagnoses being treated accordingly. The surgery performed was not radical: focal excision of the tumor was done and the capsule was entirely removed. No signs of avascular necrosis and no signs of neoplastic process recurrence were observed during 3 years follow-up.

Bone Neoplasms↗
PubMed1998

Transforming growth factor beta is essential for spindle cell conversion of mouse skin carcinoma in vivo: implications for tumor invasion.

Transforming growth factor beta1 (TGF-beta1) regulates both cell growth and cellular plasticity and is therefore important in the molecular control of both the developmental and neoplastic processes. It has been suggested that TGF-beta1 may be a positive or negative regulator of tumorigenesis. Stimulation of tumorigenesis could be due to its action as an immunosuppressor or as an inducer of angiogenesis, or by its direct action on the cell in promoting cellular plasticity. In the current study, we provide evidence that TGF-beta1 can act directly on keratinocytes in vivo to induce the reversible epithelial-mesenchymal conversion of a malignant metastatic keratinocyte cell line. Two squamous clones from the cell line were shown to undergo a reversible conversion to a fibroblastoid phenotype after culture in 1 ng/ml TGF-beta1. The morphological conversion became apparent at 24 h post-TGF-beta treatment and was complete after another 24 h. The conversion was characterized by a rapid delocalization of E-cadherin within 6-12 h posttreatment, followed by down-regulation of E-cadherin levels by 72 h. These squamous clones spontaneously converted to a fibroblastoid phenotype after s.c. injection in nude mice. Importantly, four of four clones that had been stably transfected with a dominant negative TGF-beta type II receptor were unable to undergo this mesenchymal switch in vivo, despite the fact that all clones stably transfected with neomyocin resistance alone retained their spindle characteristics in vivo. This demonstrates that the epithelial-mesenchymal conversion event is mediated directly via the TGF-beta signaling pathway of the tumor cell per se, and that it is sufficient to significantly enhance tumorigenicity and the malignant and invasive characteristics of the tumor in vivo.

Animals↗
PubMed1998

[Flow cytometry sutdy of DNA and cell kinetics in the adenoma- carcinoma sequence in the large intestine].

UNLABELLED: The quantitation of DNA and growth fraction in the different step from dysplastic to neoplastic process in large bowel is the aim of this study. 70 colonic polyps were studied. The fresh specimens were processed and DNA analysis was carried out using a Partec CA II flow cytometer and the growth fraction was tested with KI-67 monoclonal antibody. The percentage of S-phase cells has been calculated with the Multicycle program. Our results demonstrated that 7 adenomas were tubulo-villous with mild dysplasia, 39 with mild-moderate dysplasia, 1 with severe dysplasia, 5 were polypoid carcinomas, 2 juvenile polyps, 1 polypoid leiomyoma, 1 inflammatory fibroid polyps. DNA analysis showed a diploid DNA content in non adenomatous polyps, in all adenomas with mild dysplasia, in 37 with mild-moderate dysplasia, in 8 cases with moderate-severe dysplasia and 1 cancer. Aneuploidy was discovered in 2 cases with mild-moderate dysplasia, in 6 cases with moderate-severe dysplasia, in the case of severe dysplasia and in 4 cases of carcinomas. Best indexes of linear correlation (Pearson's r) has been found between S-phase and DNA index (r = .75) and between S-phase and KI-67 (r = .82). IN CONCLUSION: 1) No relationship was found between DNA content and age, sex, size and location of polyps. 2) Aneuploidy is strictly related to moderate-severe grade of dysplasia therefore it is an important element in the development of adenomacarcinoma sequence. 3) DNA-index, S-phase and KI-67 are strictly related.

Adenocarcinoma↗
PubMed1998

The immunohistochemical marker Ki-S2: cell cycle kinetics and tissue distribution of a novel proliferation-specific antigen.

The monoclonal antibody Ki-S2 binds to a recently characterized proliferation-specific protein, p100. To assess its distribution pattern under physiologic and pathologic conditions, we performed immunohistochemical analyses on an exhaustive spectrum of normal tissues, 624 miscellaneous solid cancers, and 95 hematologic malignancies, and compared the results with Ki-67 immunostaining on consecutive sections. In addition, Ki-S2 expression was related to the DNA content by dual parameter flow cytometric analysis in parallel with Ki-67 labeling using a human cancer cell line. Immunoreactivity was enhanced at the G1/S transition and persisted through G2 and M phase. After adequate antigen retrieval, the antibody was found to yield identical results on fresh and formalin-fixed, paraffin-embedded material. The antibody specifically labeled actively proliferating cells, which constitute a subset of the population recognized by Ki-67. In normal human tissues, Ki-S2 immunolabeling hardly ever exceeded 40% of the Ki-67+ cell fraction. Immunoreactive scores of the two antibodies exhibited a linear correlation, but statistically significant differences in the ratio of Ki-S2-positive to Ki-67-positive cells were nevertheless observed between different tissue types. In contrast, the ratio of Ki-S2 and Ki-67 immunoreactive scores varied widely in neoplastic cells and tissues, occasionally attaining a ratio of almost 1:1. This suggests that loss of growth regulatory mechanisms in malignant cells might result in an extreme reduction of the G1 phase fraction and thus in a significantly shorter doubling time. Therefore, antibody Ki-S2 is likely to allow a more precise evaluation of the cell fraction that will complete a division cycle and a more confident appraisal of the malignancy potential of a neoplastic process.

Antibodies, Monoclonal↗
PubMed1998

Cholecystadenocarcinoma in a cat.

A malignant neoplastic process originating from gall bladder epithelium was diagnosed in a 14-year-old, spayed female, domestic shorthair cat. The tumor produced widespread pulmonary and lymphatic metastases. The clinical and pathological manifestations are described. Neoplasia arising from the gall bladder epithelium is rarely reported in animals.

Adenocarcinoma↗
PubMed1997

Microvasculature of the human fetal laryngeal anterior commissure.

The vascular pattern of the injected with Mercox human fetal larynges, especially of the anterior commissure and surrounding it area, was analysed within the horizontal and frontal sections under a light microscope. The main result of our study was confirmation of existence of the avascular "plane zero" situated above the anterior commissure, which separates that structure from the supraglottic tier. That finding i.e. avascular separation between teh middle and upper laryngeal compartments, already present in the fetal period, has clinical implications as far as the spread of neoplastic process within the larynx is cancerued.

Case-Control Studies↗
PubMedDate not supplied

[Treatment of advanced pancreatic cancer with interferon alpha, tumor necrosis factor and 5-fluorouracil (preliminary report].

This paper presents the first outcomes of a combined therapy of advanced cancer of pancreas with Interferon alpha, Tumor Necrosis and 5-Fluorouracil. Every subject underwent surgical treatment, but only in two cases partial resection was done. In the other subject only palliative operations were performed because of advances stages of neoplastic process. All patients were followed up during the time ranged between from 2.5-13.5 months. Complete remission was observed in one patient (survival time--9 months). In three subjects partial remission was reported, whereas in the left part of our cohort the general condition was steady. This research would be continued.

Adenocarcinoma↗
PubMed1998

[Down's syndrome and leukemia].

OBJECTIVE: Children with Down's Syndrome (DS) have a high risk for leukemia and need special clinical management. For this reason we have reviewed our experience. PATIENTS AND METHODS: All children with DS diagnosed a having acute leukemia during a 21-year period were reviewed retrospectively. Treatment was administered according to current protocols in our unit at the time of diagnosis without any initial modification. RESULTS: There were 13 children with DS and acute leukemia [6 ALL, 4 AML and 3 transient leukemias (TL)]. No patient presented CNS leukemia at diagnosis. All children with AML and DS were under three years of age and standard treatments did not achieve satisfactory results. TL regressed in two newborns without developing AMKL later. Five out of six patients with DS and ALL achieved complete remission. Currently, 4 of these children are alive and off therapy. Toxicities related to treatment were observed in almost all of the patients. CONCLUSIONS: Children with DS suffer a higher risk of developing leukemia. They should receive standard protocols, but aggressive supportive care might be provided as they have a higher incidence of treatment related toxicities. Prognosis of these children is similar or even better in some cases than children without DS. TL is a true neoplastic process capable of spontaneous remission and it can progress to AMKL.

Acute Disease↗