Expression of insulin-like growth factor receptor type 1 correlate with lymphatic metastases in human gastric cancer.

Most patients with gastric cancer are diagnosed at advanced clinical stages with a high frequency of lymph node metastasis. It is very important to find novel factors for the early diagnostic and prognostic evaluation of gastric cancer. It has been shown that IGF-1R activates mitotic division and inhibits apoptosis of cancer cells through the activation of signaling MAP/ERK and PI3K/Akt-1 pathways. IGF-1R plays a role in cell transformation and maintenance of the phenotype in modified cells. Moreover, an IGF-1 receptor effect influences the processes of adhesion, migration, invasion and metastasis of tumor cells. The aim of the study was to assess the expression of IGF-1R in gastric carcinoma in correlation with selected anatomo-clinical parameters. The study enrolled a group of 49 patients treated surgically for gastric cancer. 28 patients had no lymph node metastases. The expression of the studied proteins was assessed using the immunohistochemical method. We found that the expression of IGF-1R in gastric cancer is associated with lymph node metastasis (p < 0.001), is correlated with worse prognosis and high histological malignancy grade, and is an independent predictor of survival in patients with gastric cancer (p < 0.001). IGF-1R may play an important role in tumor growth and metastasis via the lymphatic pathway.

Effects of perioperative immunostimulating nutritional therapy on the phagocytic activity of blood platelets in patients with various clinical stages of gastric cancer.

PURPOSE: The aim of this study was to evaluate the total blood platelets count, fraction of phagocytizing thrombocytes (PhT%), and phagocytic index of thrombocytes (PhIT) in gastric cancer considering the stage of the disease, and perioperative immunonutrition support. METHODS: Our study included 44 patients operated for gastric cancer divided into 2 groups depending on the clinical stage, and 40 healthy volunteers -a control group. Group I included 18 patients with stage I-III locoregional malignancies and Group II included 26 patients with stage IV peritoneal dissemination. All patients received immunonutrition during the perioperative period. The phagocytic activity of blood platelets was assessed by measuring PhT% and PhIT prior to and after nutritional therapy. RESULTS: In Group I, the pre-treatment PhT% and PhIT amounted to 1.08 and 0.99, respectively, and 1.26, and 1.1 after the therapy (p<0.01). In Group II, pre-treatment PhT% and PhIT were 1.12 and 0.97, after 1.18 and 1.06, respectively (p<0.05). In the controls, PhT% and PhIT were 2.26 and 1.83, respectively, significantly higher comparing to gastric cancer patients (p<0.01). CONCLUSION: Severe impairment of the thrombocyte phagocytic activity in gastric cancer patients has been found. Phagocytic activity of blood platelets was partially improved as a result of perioperative immunonutrition both in locoregional disease and in peritoneal dissemination.

Parenteral nutrition and preOp preparation in prevention of post-operative insulin resistance in gastrointestinal carcinoma.

PURPOSE: The aim was to compare preventive effect of total parenteral nutrition (TPN) and oral nutrition (preOp) on the perioperative insulin resistance prevention in surgical gastrointestinal cancer patients. MATERIAL/METHODS: The study was conducted in a group of 75 elective gastric and large intestine cancer patients. Patients were randomly divided into 3 study groups, 25 patients each: group I (NIL) - no preparations influencing tissue sensitivity to insulin, group II (TPN) - total parenteral nutrition in its preoperative stage and group III (TPN + preOp) parenteral nutrition and preOp in the preoperative phase. RESULTS: Immediately after the surgery, no statistically significant differences in insulin resistance level between groups were observed. During the first 6 postoperative hours, a statistically significant decrease of insulin resistance level in the TPN+ preOp group in comparison to others, was observed. During the first 24 postoperative hours, the NIL group was the only one to keep the insulin resistance level the same as in the preoperative phase. CONCLUSIONS: Application of TPN in the preoperative phase leads to shortening of perioperative insulin resistance time. Combining TPN with oral application of carbohydrate before surgical procedure is an effective and the best method in postoperative insulin resistance syndrome prevention.

Immunohistochemical assessment of apoptosis-associated proteins: p53, Bcl-xL, Bax and Bak in gastric cancer cells in correlation with clinical and pathomorphological factors.

PURPOSE: The p53 protein as well as Bcl-2 family proteins such as Bax, Bak and Bcl-xL regulate apoptosis. The study objective was to analyze the expression of p53, Bak, Bcl-xL and Bax in gastric cancer and in healthy gastric mucosa. MATERIAL AND METHODS: The study group consisted of 66 patients with gastric cancer, treated surgically in II Department of General and Gastroenterological Surgery, Medical University of Bialystok. The expression of the studied proteins was assessed using the immunohistochemical method. RESULTS: Significant differences were found in the expressions of the studied proteins as compared to healthy gastric mucosa. The expressions of p53 and Bax were significantly higher (70% vs 13% and 50% vs 13%), whereas those of Bak and Bcl-xL significantly lower (18% vs 83% and 74% vs 97%) in cancer cells than in normal mucosa (p<0.001). Significant differences were also noted in the expressions of Bax and Bcl-xL in relation to histological type. In the intestinal type (Lauren I), the expressions of Bax and Bcl-xL were higher as compared to the diffuse type (Lauren II) (93% vs 43% and 91% vs 43%). Simultaneously, correlations were noted between changes in the expression of Bax vs Bcl-xL and Bak. High expression of Bax showed a positive correlation with reduced Bak and Bcl-xL (p<0.05). Moreover, positive expression of p53 caused poorer distant survival of patients (p<0.05). CONCLUSION: Our study concluded that disturbances in the expression of p53, Bax, Bcl-xL and Bak proteins are associated with their involvement in the process of carcinogenesis in the stomach. It is suggesting that they might appeared in the early phase of carcinogenesis.

Platelet activation in patients with advanced gastric cancer.

The aim of this study was to evaluate platelet activation in gastric cancer patients with regard to histopathological classification and the presence of distant metastases, by using platelet morphological parameters: MPV, L-PLT, MPC, as well as quantitative evaluation of surface receptor expression: CD41a, CD61, CD42b, CD62P, by flow cytometry at the resting state and after TRAP activation. In gastric cancer patients higher values of MPV and LP, as well as decreased MPC values were determined. Quantitative evaluation of surface antigen expression also revealed higher number of CD41a, CD61 and CD62P molecules, as compared with the platelets in the control group. Significant decrease of CD42b molecules' number after TRAP incubation, and the increased CD41a, CD61 and CD62P expression also point to the retained reactivation capacity of platelets. Good correlation between morphological parameters and the number of CD62P molecules indicates the usefulness of routine tests in evaluation of platelet activation.

Bactericidal capacity of platelets in gastric cancer patients.

The aim of this study was to evaluate bactericidal capacity of platelets in patients suffering from gastric cancer. Number of platelets and their bactericidal activity were measured in 32 cancer patients (divided into 2 groups: I--resectable cancer, II--non-resectable one) and 32 normal donors. In group I the number of platelets was 259.136+/-84.459 x 103/microl. It was increased comparing to the normal donors 193.219+/-55.493 x 103/microl. After the surgery increase in platelet number was observed (472.05+/-111.772 x 103/microl). In group II an increased number of platelets was observed (265.1+/-81.813 x 103/microl) and it was maintained in a post-operative period: 234.2+/-54.141 x 103/microl. In group I bactericidal capacity of platelets was 2.25+/-7.33%, whereas it increased significantly after the surgery--4.7+/-7.46%. In group II, it was 8.6+/-17.61% before and 4.72+/-4.76% after the surgery. In normal donors this ability was 21.66+/-16.66. In gastric cancer patients increased platelet number was observed. Significant increase in platelets number occurred after a radical tumor removal. Decreased bactericidal activity of platelets was noticed in gastric cancer patients. After surgical removal of the tumor, platelets partly reclaimed bactericidal capacity. In patients presenting disseminated gastric cancer, bactericidal capacity of platelets could be permanently impaired.

[Laparoscopic cholecystectomy conversion--causes and surgical procedures]. / Konwersje cholecystektomii laparoskopowej--przyczyny i postepowanie chirurgiczne.

From September 1993 tol May 1997 360 laparoscopic cholecystectomies have been performed in patients aged 17-74: 318 women (88.3%) and 42 men (11.7%). 19 of them (5.3%) required a conversion to open surgery. In 13 cases (13.6%) conversion was caused by technical difficulties. In the other 6 (1.7%) was caused by intraoperative complications. While converted 15 simple cholecystectomies were performed, 2 with T-tube drainage of bile ducts, 1 with anastomosis choledochoduodenalis and 1 with partial stomach resection (Rydygier method). In all cases adhesions were divided. None of the patients died. Authors believe that LCh can be performed safely on most of the patients with chronic and acute cholecystitis.

Lithogenecity of bile in the pathogenesis of cholelithiasis.

The authors have made a review of the present literature relating to lithogenic bile as the main pathogenic factor in the creation of cholelithiasis. Lithogenic bile is formed in result of complex biochemical reactions taking place in bile under physiological conditions, as well as in pathology of the liver and the biliary tract. Significant clinical implications result from the analysis.

Surgical treatment of prolapse of the rectum--evaluation of distant results.

In the years 1972-1995 41 patients suffering from prolapse of the rectum were operated according to the Moore method. The method is based on the observations which suggest that the cause of prolapse is intestinal intussusception which can be prevented by translocating the anus under the pubic joint. The observation time is from 1 to 23 years. Two patients were reoperated; one-as a result of a recurrence of rectal prolapse and one due to a post-operative adhesive ileus. One patient died as result of peritonitis following an overlooked microperforation in the rectal wall. In the case of the remaining patients, the treatment was fully successful. Regular defecation cycle as well as incontination of stool and flatus returned and the anal sphincters almost fully regained their tension in comparison to the pre-operative state. Early and distant results of surgery of prolapse of the rectum are satisfactory.

Study of lithogenicity of bile among patients suffering from cholecystolithiasis and among patients not suffering from this disease.

On the basis of biochemical and morphological research, the authors decided to attempt to determine the degree of lithogenicity of the bile among patients suffering from cholecystolithiasis (100 patients) and those not suffering from this disease (31 patients). Having analyzed the obtained data, it can be concluded that the degree of lithogenicity of bile is influenced by the concentration of cholesterol, bile acids and phospholipids as well as the damage of the liver and of the wall of the gallbladder as well as its kinetics. Lithogenic bile was noticed in 84% of the patients of group I and in 54% in group II. However, the degree of lithogenicity was significantly higher in patients suffering from cholecystolithiasis. According to the authors, the degree of lithogenicity is the deciding factor in the creation of bile stones.