VEGF Expression in Pancreatic Cancer and Other Malignancies: A Review of the Literature.

Angiogenesis is a crucial event for tumor growth and it is regulated predominantly by several different growth factors. Vascular endothelial growth factor protein family (VEGF) and its receptors are probably the most important tissue factors responsible for angioblast differentiation and tube formation. VEGF protein family currently comprises several members: VEGF (or VEGF-A), VEGF-B, VEGF-C and VEGF-D, VEGF-F, placental growth factor (PlGF), and their receptors VEGFR-1, VEGFR-2 and VEGFR-3. VEGF is a key angiogenic growth factor and its level of expression is a critical marker for detection of the angiogenic diseases. The potent role of VEGF in tumor angiogenesis has been widely described in the past decade, being expressed in most types of nondigestive and digestive cancers. VEGF family members play an important role in the development of pancreatic cancer (especially VEGF-A, VEGF-C, VEGF-D, VEGFR-1 and VEGFR-2). VEGF-A is the most specific and prominent angiogenic factor among all family members and VEGFR-2 is the most important receptor in evaluating the angiogenesis in pancreatic cancer. Thus, VEGF overexpression may be considered as a diagnostic marker and as a poor prognostic factor of the disease.

Surgical management of the esogastric junction adenocarcinoma according to its histological types.

Most adenocarcinomas of the esophagus occur in the area of the cardia and originate in islands of gastrointestinal mucosa, less often in the submucosal glands, and are usually histologically similar to gastric adenocarcinoma and its various histological patterns. Most tumors are well differentiated. All patients included in this study were diagnosed with adenocarcinoma of the esogastric junction through prior endoscopy and histopathological examination of the biopsies. Patients with resectable tumors underwent surgical resection followed by histopathological examination of the resected samples. The most frequently encountered tumor was represented by type III, subcardial adenocarcinoma in 68% of all cases. The main surgical procedure was distal esophagectomy with total gastrectomy extended by abdominal transthoracic approach. All the studied cases were diagnosed with adenocarcinoma of the gastro-esophageal junction. The majority of them were well-differentiated being easily recognized by their submucosal invasion. We believe that surgery with curative intent is superior to curative palliative treatment.

[Struma ovarii]. / Struma ovarii.

UNLABELLED: Struma ovarii is a rare tumor in its pure form, but its true incidence is hard to estimate because of all the variation in the diagnostic criteria due to the fact that some authors reported it as within a teratoma and others only in its pure form. In general, it is an asymptomatic tumor, "benign-like" in most of the cases, and the diagnostic is based only on the histopathological findings. MATERIAL AND METHOD: This is a retrospective study of all ovarian tumors treated in our departments over a period of 11 years, from January 1, 1995 to January 1, 2006. RESULTS: All medical records of 644 patients were reviewed, of which 502 patients (77.96%) with unilateral tumors and 142 (22.04%) with bilateral involvement. 879 tumors were removed: 88.39% benign and 11.61% malignant. Struma ovarii was demonstrated in 2 patients. The only complaint in these 2 patients diagnosed and treated in our clinics was pain in the lower abdomen. The clinical examination and ultrasound suggested ovarian tumors, but the diagnosis was made on the histopathological findings. Following surgical treatment (classic or laparoscopic) the postoperative course was excellent, confirming that this approach is the only practical solution.

[Crohn's disease. Clinical and therapeutical considerations]. / Boala Crohn. Consideratii clinicoterapeutice.

Crohn's disease is a chronic granulomatous inflammatory condition of the intestinal tract of unknown etiology. Most commonly the disease affects the small bowel, the colon and the rectum. The acute and aggressive forms can evolve fast, mimicking an acute surgical illness, requiring surgical intervention in emergency. Surgical therapeutical option, in this condition, must be determined strictly by establishing a correct intraoperative diagnosis, through macroscopic features and histologic evidence. Because it is an incurable disease with variable evolution, marked by recurrence, that involves repeated surgical intervention, the surgical treatment (often resection), must be most conservative from the small bowel. We present 3 cases of surgical interventions with emergency characteristics (bowel obstruction through fitobezoar, colonic tumors obstruction of colon splenic angle, urachal infected tumors). In these cases the diagnosis was established intraoperatively and the surgical intervention was adapted to the particular cases.

[Hydatic cyst of the liver. Considerations on 337 cases]. / Chistul hidatic hepatic. Consideratii asupra a 337 cazuri.

Hydatid disease of the liver is still endemic in certain parts of the world. The modern treatment of hydatid cyst of the liver varies from surgical intervention to percutaneous drainage or medical therapy. Surgery is still the treatment of choice and can be performed by the conventional or laparoscopic approach. The aim of the study is to analyze the results of the surgical treatment in hydatid disease of the liver in First Surgical Clinic, Iasi. The study concerned a period of 12.5 years (1992 - 31.07.2004) and it included 337 cases. There were performed radical procedures (ideal cystectomy - 17 cases - 5.04%, hepatic segmentectomy - 8 cases - 1.48%, atypical hepatectomy - 10 cases - 2.96%) or conservative procedures (de-roofing - 37 cases - 10.97%, subtotal pericystectomy - 34 cases -10.80%, total pericystectomy - 19 cases - 5.63%, partial pericystectomy - 212 cases -62.90%). In 35 cases (10.38%) the operation was started laparoscopically and 12 cases needed conversion. Postoperative course was complicated in 112 cases (33.32%) (external biliary fistula, cavity suppuration, residual cavity hydatid relapse). Radical methods constituted operations that had excellent results, but they are feasible in few cases. Conservative procedures, relatively simple and still accepted, have a higher rate of morbidity. The laparoscopic approach is more and more used, with good results.

[Tendencies and results in rectal cancer treatment]. / Tendinte si rezultate în tratamentul actual al cancerului rectal.

UNLABELLED: Rectal cancer is one of the leading cause of cancer-related death worldwide despite of multimodal treatment. OBJECTIVE: The aim of this study is to review the management strategies for rectal cancer and to determine morbidity after multimodal therapy. METHOD: Retrospective study about 276 patients with rectal cancer surgically treated in 1st Surgical Clinic of "St. Spiridon" Hospital Iasi, Romania, between 1998-September 2003. RESULTS: There were 166 men (60.14%) and 110 women (38.86%) with mean age 63.6 years (extreme 20-81 years). The tumor's staging was: stage I--12 cases (4.5%); stage II--59 cases (21.3%); stage III--134 cases (48.2%), stage IV--71 cases (25.7%). 37 patients (13.4%) received preoperative radiotherapy (20 Gy). The tumor was resectable in 204 cases (74%) with curative purpose in 190 cases (68.8%). The postoperative therapy was performed in 198 cases (71.7%). The postoperative morbidity was documented in 32 cases and 24 patients died during hospitalisation (8.7%). Long-term results are also exposed with a review of literature. CONCLUSIONS: Rectal cancer has been notoriously difficult to treat successfully but there are numerous attempts modifying existing therapeutic regimens or designing new ones.

Serological profile of sporadic acute viral hepatitis in an area of hyper-endemic hepatitis B virus infection.

BACKGROUND: Located in the south western part of Saudi Arabia, the Gizan region is largely a rural community in which hepatitis B and chronic liver disease including hepatocellular carcinoma are highly prevalent. AIM OF STUDY: To determine the relative frequencies of acute hepatitis A, B, C and E in acute viral hepatitis in an area of hyperendemic hepatitis B infection. METHODS AND MATERIALS: In a prospective study 246 consecutive patients (179 males and 67 females) diagnosed in a 2-year period were tested for markers of Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C (HCV) and hepatitis E virus (HEV). RESULTS: Of the patients tested, 131 (53.3%) were children ( < 10 years), and 42 (17%) were 11 - 20 years in age. Ig M anti -HAV, IgM anti-HBV, anti- HCV and IgM anti-HEV were positive in 37%, 19.1%, 3.7% and 13.7% respectively. Markers of these viruses were absent in 24.4%. Among 131 children (< 10 years) the commonest cause of AVH was HAV occurring in 57.3% of the cases. In adults (> 21 years) HBV was found in 35.6% and IgM anti -HAV was detected in only 6.8%. In contrast to the age- related decline in the frequency of acute HA, the proportion of acute HE were similar in all age groups (13.7% in children, 16.7% in adolescents and 11.0% in adults). CONCLUSION: The study indicated that HAV is still a common cause of AVH particularly among children in Gizan. Acute 1-113 had a low occurrence among the children, evidently as a consequence of the integration of HB vaccine into the Saudi Arabian national EPI, 10 years ago. With the availability of combined HB and HA vaccines, It should be possible to graft the vaccination against HAV on to the existing program in Saudi Arabia. Affecting 13.4% of the group studied, sporadic HEV constitute a significant cause of AVH in this population. Until HEV vaccine becomes widely available, its prevention would be mainly by the improvement of socio - economic and hygienic standards of the population.

Cellular immune response in atypical tuberculosis diagnosed by PCR in paraffin embedded material.

The aim was to evaluate the cellular immune response in atypical tuberculosis and granulomatous inflammation consistent with tuberculosis (TBC), negative histochemically for acid-fast bacilli and analysed by PCR for Mycobacterium tuberculosis (MT) detection in paraffin-embedded tissue. Thirty six samples of differently localized atypical tuberculous lesions and granulomatous tuberculoid lesions negative for acid fast bacilli and 4 positive cases on Ziehl-Nielsen stain were analysed by PCR for MT detection and were tested immunohistochemically (IHC) for the cellular immune response in the granulomas and perigranulomatous tissue. The samples selected were: 7 pulmonary and 33 extrapulmonary specimens, especially lymph nodes. Histologically, the atypical tuberculous lesions contained supurative necrosis, defective granulomas and cellular polymorphism. The epithelioid cells showed frequent mitoses. The immunoprofile of cells was polymorphous. L26 positive small lymphocytes were found in nodular lymphoid aggregates surrounding granulomas. A significantly increased number of positive UCHL1 cells were found in 33 out of the 40 analysed cases, with a larger percentage of CD4 positive T cells (81.8% of cases). CD44 was positive in multinucleated giant cells (17.5% of cases), epithelioid cells (60% of cases) and lymphocytes (30% of cases). CD68 was localized in multinucleated giant cells and epithelioid cells, in a 4%, respectively 62.5% of cases. The PCR was performed in all 40 cases; the tissue samples were heterogeneous (lung, lymph nodes, lever, nasopharynx, etc.) and needed a good quality extraction of DNA. Performing a control PCR for Beta Globin tested the extraction; a good result was obtained in 31 cases (77.5%); from these, 19 cases had amplification for IS 6110. The cellular immune response in the atypical tuberculous lesions was similar in cases with and without acid-fast bacilli, but positive for PCR. In the most cases with negative PCR reaction, it was due to a deficient fixation of the material. The T lymphocytes were numerous in all types of tuberculous granulomas, with the prominence of CD4 positive subtype. The immunoprofile of the epithelioid cells, positive for CD44 and CD68, presenting frequently mitoses suggests an activate state in a possible relationship to the T-cell-mediated immune response in tuberculosis.

Pattern of gastrointestinal diseases in adult patients admitted to Samtah General Hospital, Gizan region, Saudi Arabia.

To determine the relative frequencies of gastrointestinal diseases (GI) in patients admitted to Samtah General Hospital, Gizan, the records of 2,442 adults admitted to the medical and surgical services for gastrointestinal diseases during the period 1413 to 1416 were analyzed retrospectively. 1,028 patients had acute appendicitis. The remaining 1,414 patients were admitted for various other GI diseases. In these 1,414 patients the commonest diseases were gastrointestinal infections (36.4%), peptic ulcer disease (19%), gall bladder disease (18.5%), viral hepatitis and its sequelae (20.7%). Despite the high prevalence of cholelithiasis, acute pancreatitis was uncommon (0.1 %). Inflammatory bowel disease was rare. There was no gender - related difference in the prevalence of gastrointestinal infections, peptic ulcer disease and carcinoma of the stomach. Males were significantly more afflicted than females with viral hepatitis (p< 0.0001), cirrhosis of the liver (p< 0.0001), hepatocellular carcinoma (p< 0.0005), variceal bleeding (p< 0.0005), and peptic ulcer bleeding (p< 0.005). As a large proportion of our patients had preventable diseases, it is expected that immunization and other public health measures will reduce the frequency of these diseases in the future.

The gastric mucosal barrier.

The gastric mucosal barrier is a complex system made up of submucosal, epithelial and mucus elements. The mucus gel layer is a thick tenacious organized layer adherent to the epithelium. Despite these properties it is composed of more than 95% water, the organization being provided by long interacting glycoprotein molecules (mucus glycoprotein or mucin). These molecules are largely made up of carbohydrate which is present in large numbers of relatively small oligosaccharide units packed around the polypeptide core. This structure provides clues to the nature of the protection afforded by the mucus layer. For example, it is relatively resistant to proteolysis in the gastrointestinal tract; it retains water in an unstirred layer; the tangled glycoproteins exclude large molecules and the carbohydrate of the oligosaccharide units mirror that at the surface of the epithelial cell. Few biochemical studies have been carried out on the effect of ulcer-healing drugs on gastric mucus. Normal subjects were, therefore, given two weeks treatment with cimetidine, carbenoxolone or misoprostol and the secretions aspirated from the unstimulated and pentagastrin-stimulated stomach. The volume of secretion and weight and carbohydrate content of non-diffusable glycoconjugates were determined for each specimen, together with the proportion of high molecular mass mucin and qualitative and quantitative analyses of the glycopolypeptide. There were no significant differences between the results for each drug or without drug. This may be because normal subjects were studied who already have an effective mucosal barrier. In addition, it is likely that the process of mucus biosynthesis and secretion in a healthy individual is relatively resistant to the action of ulcer healing drugs.

The presence of polysaccharide in normal human gastric mucus.

Polysaccharide material was found in the proteolysis glycopolypeptide fraction from normal human gastric mucus. The polysaccharide was identified by carbohydrate and amino acid analyses, by elemental analysis and from its behaviour on density-gradient ultracentrifugation. The polysaccharide is polydisperse with a weight-average molecular mass of 300 000 Da. Over 85% of the polysaccharide consists of galactose, and this represents 26% of all the galactose present in the fractions after beta-elimination with reduction of the glycopolypeptide material.