ABSTRACT
Allergic asthma is characterized by airway hyper responsiveness and inflammation with tissue and bronchial infiltration by activated eosinophils, T cells, mast cells, and macrophages. The extensive infiltration of eosinophils into the lung is not only a hallmark of allergic asthma but also contributes too much of the damage of respiratory epithelium during late phase airway responses. There is accumulating evidence that chemokines, especially the C-C subfamily, are involved in both the migration and the activation of eosinophil and other leukocytes during asthma responses. Chemokines implicated in asthma include regulated on activation, normal T cell expressed and secreted [RANTES] and C-C chemokine eotaxin. Chemoattractants, including eotaxin, and RANTES, lead to characteristic infiltration by eosinophils, basophils, Th2 lymphocytes, and mast cells in chronic allergic rhinitis. Increased contents of the C-C chemokines, RANTES and eotaxin, were demonstrated in the lesional scales of atopic dermatitis [AD]. Twenty nine patients with a physician diagnosis of asthma and positive skin-prick responses to at least one common aeroallergen were allocated to subgroups according to disease severity as severe asthma [n=12] and mild asthma [n=17] groups. Subjects with asthma were further divided into those with respiratory virus infection [n=10] and those where no respiratory virus infection [n=19]. They were compared with control group of 10 nonsmoking subjects with no positive skin-prick response to common aeroallergens or history of respiratory disease. Regarding allergic rhinitis, subjects were divided into severe allergic rhinitis group [n=10] and mild group [n=10]. Another group of allergic rhinitis patients with nasal polyposis were included as nasal tissue group [n=9]. All previous groups were compared with nonsmoking subjects with no positive skin-prick response to common aeroallergens or history of respiratory disease acted as a control group [n=10]. AD patients were classified into 2 groups, severe AD [n=10], mild to moderate AD [n=10], and a third group [n=10] of apparently normal persons as controls. Scales were collected from skin lesions of AD patients, who had no obvious lesions in their sole skin [n=10]. The mean values of Eotaxin, RANTES, TNF-alpha, eosinophils in severe asthma [70.77 +/- 40.17 pg/ml, 31.27 +/-51.64 pg/ml, 55.36 +/-23.94 pg/ml, 8.91 +/-3.39] are statistically higher than in mild asthma [10.38 +/-7.24 pg/ml, 3.82 +/-1.77 pg/ml, 17.98 +/-10.2 pg/ml, 6.41 +/-2.89] and the mean values of all these parameters were higher in both groups compared to control group [1.88 +/-1.11 pg/ml, 1.14 +/-0.47 pg/ml, 1.30 +/-0.44 pg/ml, 0.0 +/-0.0]. Among 29 allergic asthma patients, 10 patients were infected with respiratory viruses [34.48%], 5 patients with severe asthma and 5 patients with mild asthma. Seven of them were infected with Rhinovirus [24.13%]. The mean values of Eotaxin, RANTES, TNF-alpha, eosinophils in allergic asthma with respiratory virus infection were [43.70 +/-50.33 pg/ml, 27.84 +/-58.85 pg/ml, 39.23 +/-39.23 pg/ml, 7.1 +/-3.72] and comparing them to those allergic asthma without respiratory infection [mild and severe] [30.99 +/-33.64 pg/ml, 8.52 +/-7.74 pg/ml, 30.41 +/-21.86 pg/ml, 7.63 +/-3.14], there were non statistically significant difference. The mean values of Eotaxin, RANTES, TNF-alpha in severe allergic rhinitis [33.6 +/-11.07 pg/ml, 72.17 +/-87.61 pg/ml, 25.47 +/-4.04 pg/ml] are statistically higher than in mild allergic rhinitis [9.80 +/-6.79 pg/ml, 10.50 +/-6.90 pg/ml, 12.99 +/-3.27 pg/ml] and the mean values of all these parameters were higher in both groups compared to control group [0.6 +/-0.69 pg/ml, 0.65 +/-0.74 pg/ml, 0.63 +/-0.54 pg/ml]. The mean values of Eotaxin, RANTES, TNF-alpha in nasal tissue [160.30 +/-51.63 pg/ml, 141.00 +/-55.52 pg/ml, 62.22 +/-7.89 pg/ml] were statistically higher compared to severe [except RANTES], mild allergic rhinitis and control groups. RANTES was not significant between severe allergic rhinitis and nasal tissue due to the wide variations in this chemokine. The mean values of Eotaxin, RANTES, TNF-alpha in severe AD [18.1 +/-9.21 pg/ml, 5.36 +/-2.38 pg/ml, 7.46 +/-0.83 pg/ml] are statistically higher than in mild AD [3.39 +/-1.91 pg/ml, 1.16 +/-0.41 pg/ml, 4.27 +/-1.19 pg/ml] and the mean values of all these parameters were higher in both groups compared to control group [0 +/-0 pg/ml, 0 +/-0 pg/ml, 1 +/-0.66 pg/ml]. The mean values of Eotaxin and RANTES, in severe and mild AD are statistically higher compared to AD [non affected sole] [0 +/-0 pg/ml, 0.3+/-0.48 pg/ml], but there was a non statistically significant difference between AD [non affected sole] and control groups. In conclusion, we emphasized the roles of Eotaxin, RANTES and TNF-alpha at the local level in the pathogenesis of allergic asthma, allergic rhinitis and AD and there relation to disease severity which may direct the attention of therapeutic trials to these locally produced cytokines
ABSTRACT
Background: Bronchial carcinoid tumors are relatively rare tumors. These tumors were wrongly considered as bronchial adenomas till 3 decades ago. Now these tumors are classified as neuroendocrine bronchopulmonary tumors of lower grade of malignancy that arise from Kulchitsky cells
Aim: to study the spectrum of pulmonary carcinoids presented from our locality, demonstrating its clinicopathological profile. Also to analyze our results of surgery for these tumors and compare it with those of other centers to define the influence of the site of the tumor, carcinoid histological category , and lymph node involvement on the outcome of surgery
Patients and methods: Forty three patients with pulmonary carcinoid tumors were surgically treated at the Department of Cardiothoracie Surgery, Mansoura University Hospitals, through a period of 10 years ending December 2003. The files of all the patients were retrospectively revised for the demographic profile, clinical data, and findings of both rigid and fiberoptic bronchoscopy done to the patients. Also data extracted from CT scans and virtual CT bronchoscopy were collected and tabulated. All the patients had pulmonary resection varying from pneumonectomy till segmentectomy , according to the location and extent of the tumors. All the resectd pulmonary specimens, along with its hilar and mediastial lymph nodes were examined histopathologically, and reviewed according to the current WHO/IASLC criteria for neuroendocrine tumors. Patients were followed up from 1 to 10 years for recurrence and long term survival in relation to both typical and atypical carcinoid categories, LN affection , central and peripheral location. Results were recorded and tabulated for deduction of statistical significance
Results: The patients had a mean age of 39.35 +/- 8.55 years [range 21-64 years], 27 were females [62.79%] and 16 were males [37.3%]. Thirty five patients were symptomatic [79.1%]. Haemoptysis was the most common presenting symptom, occurring in 22 patients [51.1%]. Only 9 patients were asymptomatic [20.9 %]. Data from CT scan and bronchoscopy revealed that 29 patients [67.4%] had central tumors while 14 cases had peripheral ones. Preoperative tissue diagnosis was obtained in 22 patients [51%]. The 43 patients has 43 Operative; 21 had lobectomies, 19 had bilobectomies, one formal and one completion pneumonectomy and one segmentectomy. Typical carcinoid type was found in 35 patients [[81.3%] and eight cases had atypical carcinoid [18.7%]. Of the 35 patients with typical carcinoid. 5 had lymph node involvement [14.2%], while 3 out of 8 cases of atypical carcinoid [37.5%] showed lymph node involvement. We had one hospital mortality [2.3%] due to pulmonary embolism in an obese male aged 61 years, W. had 10 postoperative complications in 6 patients [13.9%] . We found no statistically significant correlation between the incidence of morbidity and hospital mortality and the carcinoid tissue type , place of the tumor or LN affection. Follow up: Out of the typical carcinoid group [34 surviving patients]. 29 Patients who had no LN involvement had 5 year disease free Survival of 96.55%. Out of the 5 cases with LN involvement had 5 year disease free survival 80%. Out of the atypical carcinoid group [8 surviving cases] , 5 cases who had no LN involvement had 5 year disease free survival 60%. Three cases with LN involvement, got 5 year disease free survival of 33% at the end of 5 years of follow up. By comparing results of different groups, significant predictors of 5 year disease free survival are typical carcinoid histology, absent mediastial LN involvement , and peripheral type of carcinoid
Conclusions: Carcinoid tumor is not uncommon bronchial tumor that affects females more than males. Long term survival is favorable in typical carcinoid with no LN affection, prognosis is better in peripheral type. atypical carcinoids have worse long term survival rates and recurrence Patterns, a wide surgical resection with LN clearance is essential for successful long term disease free Survival