Serum IL-5 and IL-13 consistently serve as the best predictors for the blood eosinophilia phenotype in adult asthmatics.

BACKGROUND: Molecular biomarkers that identify the phenotype of blood eosinophilia were evaluated in adult asthmatics, and their relationship with clinically significant asthma outcomes was assessed. Patients were clustered based on their molecular fingerprint. METHODS: At inclusion, 64 patients were evaluated for phenotypic traits, sputum and blood eosinophilia, exhaled NO, serum cytokines and chemokines, total serum IgE, lung function (LF), and airway hyper-responsiveness (AHR). Within-patient changes were evaluated in 44 patients 6 weeks later. RESULTS: Lung function, asthma control, and monocyte chemotactic protein-1 (MCP-1) were identified as the most important distinguisher and blood eosinophilia as second most important identifier in principal component analysis. A robust relationship was observed between blood eosinophilia and IL-5, IL-13, and eosinophil-derived neurotoxin (EDN), which stayed consistent after 6 weeks. Serum IL-5 and IL-13 were the two best, followed by EDN as separators of high vs low blood eosinophilia. Periostin did not identify blood or sputum eosinophilia, even after stratification for total IgE, and did not correlate with IL-5, IL-13, eotaxin, or EDN. IL-5 and IL-13 showed strong correlations with AHR and monocyte chemoattractant protein (MCP)-1 with asthma severity and fast LF decline. The presence of high or low expression of MCP-1, eotaxin, and IL-8 identified two separate blood eosinophilia patient clusters linked to asthma severity. CONCLUSION: Serum IL-5 and IL-13 are reliable biomarkers for the blood eosinophilia asthma phenotype. High or low expression of MCP-1, eotaxin, and IL-8 discriminates between eosinophilic asthma severity clusters.

[Biliodigestive anastomoses; a modality for resolving mechanical jaundice]. / Anastomoze biliodigestive; modalitate de rezolvare a icterului mecanic.

Over a period of 14 years a total of 1,996 surgical procedures have been performed on extrahepatic biliary pathways. In 182 cases (9.11%) biliodigestive anastomoses have been done for a therapeutical solution of mechanical jaundice. Biliodigestive anastomoses have been mandatory in 76 cases (41.76%) because of mechanical jaundice induced by biliary stones. In 106 cases the anastomosis was carried out in an attempt to solve mechanical jaundice that was not induced by biliary stones but by other causes. In 45 cases the lesions that had determined the jaundice were benign, and in 61 of the cases malignancy was at the origin of the jaundice. The following types of anastomosis were employed: choledochoduodenal anastomoses were done in 120 cases (65.93%); hepatic duct-duodenal anastomoses in 15 cases (19.23%); hepatojejunal anastomoses in 7 cases (3.84%); recalibration of previous anastomoses in 5 cases (2.74%). These surgical methods, applied in cases of various etiologies, most of them quite severe, in debilitated patients, with iterative surgery, were associated with early postoperative mortality of 8% (13 cases), and a general morbidity of 35% (65 cases), which included: fistulae, anastomotic stenoses, acute postoperative pancreatitis, angiocholitis and suppuration. The late results were good, depending on the etiology of the mechanical jaundice. The authors preferred choledochoduodenal anastomosis for benign lesions, and anastomoses with the diverticular apparatus, or the main biliary pathway in palliative surgery.

[Comparative clinico-evolutive and therapeutic aspects in cancer of the right and left colon]. / Aspecte comparative clinico-evolutive si terapeutice în cancerul de colon drept si stîng.

The paper reports on the casuistics of the colon cancer in the Clinic of Surgery of the "Grivita" Clinical Hospital, for 21 years (1966-1986) with emphasis on the situs peculiarities on the right and left colon. Whereas the left colon cancer (LCC) started in 32% of cases with subocclusive and occlusive syndromes having special implications on the treatment and prognosis, in the right colon cancer (RCC) only in 3.5% of cases the diagnosis was established in the stage of subocclusive syndrome. During surgery the metastatic adenopathy was met in 57% in LCC and only in 37% in RCC, and the hepatic metastases in 17.7% in LCC and in 10.9% in the RCC cases. The immediate postsurgery mortality was present in 12% of the LCC cases and in only 9.3% of the RCC cases. In the last 10 years of the period studied, the patients were periodically readmitted into the hospital, reinvestigated, and monochemotherapy with 5-fluorouracil was applied in sequential cures. In this last period, the survival at 5 years was of 25 (45.4%) in the 55 patients operated for RCC and of 41 (37.6%) in the 109 patients operated for LCC.