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INTRODUCTION: Endoscopic submucosal dissection (ESD) of early neoplasias of the gastrointestinal tract (GIT) has been increasingly applied as an alternative to invasive surgical procedures, with the aim to preserve the patient's organ and quality of life, although it does not allow the histopathological analysis of lymph nodes. Previous studies demonstrated that the presence of neoplastic emboli in lymphatic (lymphatic vascular invasion [LVI]) or blood vessels (blood vascular invasion [BVI]) is considered a positive predictive factor for the occurrence of lymph node metastasis. The assessment of vascular invasion carried out only by routine hematoxylin and eosin staining (HE) may yield both falsepositive and false-negative results. D2-40 is a specific monoclonal antibody to the lymphatic endothelium. Thus, it is useful for identifying LVI and distinguishing if tumor embolization is found in blood or lymphatic vessels. OBJECTIVE: To determine the role of immunohistochemistry (IHC) in the assessment of ESD specimens by comparing the detection of LVI and BVI by HE and IHC with D2-40 and CD34 immunolabeling. METHOD: We conducted the IHC study using D2-40 and CD34 markers (pan-endothelial) in 30 cases of ESD with histological diagnosis of carcinoma in order to assess the presence of LVI and BVI. RESULTS: The detection of LVI was more prevalent than BVI. Three out of six cases with LVI were false-positive by HE and six were false-negative by IHC. Regarding BVI, five cases were identified and one was false-negative by IHC. CONCLUSION: Our results indicated that the histopathological analysis of ESD specimens by exclusively routine HE staining does not allow proper evaluation of BVI or LVI.
INTRODUÇÃO: A dissecção endoscópica da submucosa (DES) de neoplasias precoces do trato gastrointestinal (TGI) tem sido cada vez mais aplicada como alternativa aos procedimentos cirúrgicos invasivos, visando a preservar o órgão e a qualidade de vida do paciente, contudo, não possibilita a avaliação histopatológica de linfonodos. Estudos anteriores demonstraram que a presença de êmbolos neoplásicos, em vasos linfáticos (invasão vascular linfática [IVL]) ou sanguíneos (invasão vascular sanguínea [IVS]), é considerada um fator preditivo positivo para ocorrência de metástase linfonodal. A avaliação da invasão vascular realizada apenas pela coloração de rotina hematoxilina e eosina (HE) pode gerar resultados falso-positivos e falso-negativos. O D2-40 é um anticorpo monoclonal específico para endotélio linfático, sendo, portanto, útil para identificar IVL e distinguir se a embolização tumoral encontra-se em vasos sanguíneos ou linfáticos. OBJETIVO: Determinar o papel do estudo imuno-histoquímico (IHQ) na avaliação de espécimes de DES, comparando a detecção de IVL e IVS, pelo HE e IHQ com marcação por D2-40 e CD34. MÉTODO: Foi realizado estudo IHQ utilizando os marcadores D2-40 e CD34 (pan-endotelial) em 30 casos de produtos de DES com diagnóstico histológico de carcinoma para avaliar a presença de IVL e IVS. RESULTADOS: A detecção de IVL foi maior que a de IVS. Dos seis casos com IVL ao HE, três eram falso-positivos e seis, falso-negativos à IHQ. Em relação à IVS, foram identificados cinco casos falsopositivos e um falso-negativo à IHQ. CONCLUSÃO: Nossos resultados indicaram que a análise histopatológica dos produtos de DES realizando apenas a coloração HE não permite a avaliação adequada da presença de IVS ou IVL.
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Objective3-nitro-L-tyrosine(3-NT)has been shown to be the marker of ONOO-productionin the tissue during septic shock.We aimed to investigate the effects of 3-NT on adrenergic receptor-mediatedvascular reactivity and the possible mechanism.Methods The experiment consisted of two parts.In part Ⅰ twenty-four male SD rats weighing 200-300g were anesthetized with intraperitoneal pentobarbital 40 mg?kg~(-1).Spontaneousbreathing was maintained.The animals were randomly divided into 2 groups:A control group received normalsaline i.v.(n=12)and B 3-NT group received 3-NT 2.5 ?mol?kg~(-1) i.v.(n=12).30 min and 90 min after 3-NT/N.S.administration the animals received i.v.phenylephrine(PE)0.5,1.0,1.5,2.0,2.5 ?g?kg~(-1)(subgroup Ⅰ)or vasopressin 1.3,2.6,3.9,5.2 ?g?kg~(-1)(subgroup Ⅱ)at 15 min intervals.The percentageincrease in MAP was recorded.In part Ⅱ six male SD rats were anesthetized and killed.The thoracic aorta wasimmediately removed and aortic rings of 3 cm in length were prepared and suspended in Krebs-Hensleit solutionmaintained at 37℃ and aerated with 95% O_2 and 5% CO_2 and prestretched with a load of 2g.Before theexperiment the response of the aortic tings to cumulative addition of PE(1?10~(-9)-3?10~(-5)mol)was prelimarilymeasured.Alter five washes the aortic rings were randomly divided into 2 groups:control group(KH solution)and 3-NT group(KH solution containing 3-NT 250 ?mol?L~(-1)).After 60 min incubation,response to PE wasmeasured in both groups and concentration-response curve was obtained and Emax and CE_50 were calculated.Results PE increased MAP in a dose-dependent manner.PE 2.5 ?g?kg~(-1) increased MAP by 20% of thebaseline value.30 and 90 min after 3-NT 2.5 ?mol?kg~(-1) the hypertensive response of the animal to PE wassignificantly inhibited but 3-NT did not affect the increase in MAP induced by vasopressin.In the isolated SD rataortic ring experiment there was no significant difference in the concentration-response curve and Emax and EC50values of PE between the 3-NT and control group.Conclusion 3-NT selectively inhibits ?-adrenoceptor mediatedhemodynamic response through mechanisms other than competitively antagonizing ?-adrenoceptor.
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Objective [WT5”BZ]To evaluate the results of radical resection for the treatment of Budd Chiari syndrome (BCS) caused by short segmental lesions in inferior vena cava (IVC), and major hepatic veins (MHV).[WT5”HZ]Methods [WT5”BZ]In this series, resection of IVC occlusive segment and orthotopic artificial vascular graft transplantation were performed in 42 patients. Resection of major hepatic vein, hepatic venous plasty and orthotopic transplantation with artificial vascular graft were performed in 10 patients. Resection of major hepatic vein, anastomosis between hepatic vein and right artrium in 3 cases. Percutaneous transhepatic angioplasty in 10 cases.[WT5”HZ]Results [WT5”BZ]One patient died of complication. 58 cases were followed up for an average of 30 months. 3 cases in interventional group suffered recurrence and one in surgical group had recurrence.[WT5”HZ]Conclusions [WT5”BZ]The treatment of BCS by resecting inflicted segment of IVC or hepatic veins and orthotopic artificial vascular graft transplantation effect a radical cure in most cases.