Interleukin-17 may be a valuable serum tumor marker in patients with colorectal carcinoma.

The promotion of tumor growth is due to a combination of several mechanisms, including angiogenesis and the abundance of cell-derived inflammatory cytokines. The aim of this study was to investigate the serum levels of interleukin 17 (IL-17) and the expression of p53 and Vascular Endothelial Growth Factor (VEGF), in order to determine the relationship between these markers and serum IL-17 levels in patients with colorectal carcinoma. Serum levels of the proinflammatory cytokine IL-17 in patients with colorectal carcinoma (CRC) (n=40) and in a healthy group (n=37) were analysed by ELISA. Surgically resected specimens of 59 colorectal carcinomas were studied by immunohistochemical staining for VEGF and p53. Analyses by ELISA showed significantly higher IL-17 serum levels in patients with colorectal carcinoma than in control subjects (IL-17; mean 128.52+/-47.62 pg/ml vs. mean 101.91+/-22.46 pg/ml; p=0.022). We also found an inverse correlation between p53 expression and the level of IL-17 in the serum of patients with CRC. In fact, the serum concentration of IL-17 was significantly higher in patients who did not express p53 (p=0.023). There was no significant correlation between the expression of p53 and VEGF. However, concomitant expression of VEGF and p53 showed a significant correlation with the histological and nuclear grade of the carcinoma. The data presented in our study indicate that IL-17 might act as a valuable tumor marker in patients with CRC and that combined analysis of p53 and VEGF expression might provide additional information about tumor features.

HER-2 expression in uterine cervix carcinogenesis.

PURPOSE: To assess the expression and clinical significance of HER-2 protooncogene in the uterine cervix carcinogenesis. PATIENTS AND METHODS: We examined 69 tissue samples of low grade cervical squamous intraepithelial lesions (SIL) (n=16), high grade SIL (n=11) portio vaginalis uteri (PVU) carcinoma in situ (n=11) and PVU invasive carcinoma, stage IA-IIA (n=13; study group) and 18 samples without SIL or malignancy (control group). The expression of HER-2 was detected immunohistochemically using a monoclonal antibody. Fisher's exact test was used to assess statistical significance. By establishing sensitivity and specificity of the test, the level of reliability of these analyses was determined as a possible screening method for early detection of changes in the uterine cervix. RESULTS: Overexpression of HER-2 was found to increase in direct relation to the grade of the cervical lesions. Statistically significant difference was found in the frequency of overexpression in patients with high grade SIL, PVU carcinoma in situ and PVU invasive carcinoma compared with the control group. High sensitivity was of great diagnostic significance for the detection of these types of changes in the uterine cervix. On the basis of high predictive values it can be concluded that in patients with HER-2 overexpression there is a great possibility that they have premalignant or malignant changes in the uterine cervix. CONCLUSION: Our results indicate that overexpression of HER-2 oncogene may play an important role in cervical carcinogenesis. However, more extensive series of samples is required to establish the prognostic significance of HER- 2 in cervical carcinogenesis.

Does tuberculosis after kidney transplantation follow the trend of tuberculosis in general population?

Despite improvement in graft survival, infection continues to be an important cause of morbidity and mortality after kidney transplantation. We analyzed the clinical courses and outcomes of 16 transplanted patients with positive cultures for mycobacterium tuberculosis. In the course of a 20 year period, there were 13 cases of tuberculosis registered that developed in 456 patients who underwent kidney transplantation in our department, and in three refugees transplanted in other centers (a prevalence of 3.13%). Five of them developed tuberculous infections during 1997. Five patients had residual tuberculosis in preoperative chest X-ray, and specific pyelonephritis as an underlying kidney disease in two of them. All patients with treated with triple immunosuppressives. Before tuberculosis onset, 14 patients experienced one or more episodes of acute rejection and were treated with steroid pulses, ALG or OKT3. Tuberculosis was diagnosed after a period of 1.5 months to 10 years after transplantation. At the time of an infection, the graft function was normal in eight patients and chronic graft failure was evident in eight patients (sCr 210-700 micromol/L). The infection was pulmonary in 12 patients; urinary in two; disseminated in two; pulmonary and urinary, pulmonary and intestinal, and pancytopenia in one patient. All patients were treated with rifampicin and isoniazid in addition to ethambutol for the first two-month period. Treatment lasted from 1-22 months. With 14 patients favorable microbiological responses were registered. Two patients died within the first six months (both with disseminated disease), and the mortality rate was 14.3%. Throughout the followup period, the graft function remained stable and normal in eight patients who had normal graft function at the time of infection onset. Although six patients recovered, progressive graft failure developed and hemodialysis was restarted in one patient two months after antituberculous therapy introduction, and in two patients three years later. Four patients died 2-14 months after AT therapy withdrawal. The causes of death were severe liver failure, cerebrovascular insult and CMV.

[Miliary tuberculosis of the lungs]. / Milijarna tuberkuloza pluca.

The study concerned 37 adults patients with miliary tuberculosis, who were treated at the Institute for Lung Diseases and Tuberculosis in Belgrade, over the period from 1987 to 1990. This number of patients is 1.37% of the total number of hospitalized patients with TB. The average age was 51 yrs (21-78). The sex distribution was equal. Associated diseases and predisposing conditions existed in 28 (76%) patients, most often haematologic diseases, systemic diseases of the connective tissue, and alcoholism. Classical X-ray finding of the lungs was present in 89% of the patients, and poor and atypical in 11%. The accompanying pleural exudation was observed in 13.5% of the patients, smaller cavernae in 5.4%, and enlarged mediastinal lymph nodes in one patient. The diagnosis of miliary TB was bacteriologically or pathohistologically confirmed in 31 (84%) patients, on autopsy in 2 cases and by antituberculotic test in 4 cases. Positive Loewenstein culture media were obtained in 62% of patients, from sputum in 64% of cases, in the liquor in 5.4%, and from the pleural fluid in 2.7% of patients. (BK was found by direct sputum microscopy in 6 pts - 16%). Positive pathohistological findings was obtained in 18 (49%) patients: by pleural biopsy in 2 cases, lung biopsy in 8 (bronchoscopy in 5 pts, aspiration needle biopsy in 2 pts), and by biopsy of extrathoracic tissues and organs in 8 pts. Early diagnosis was established in 62% patients.

Targeting of non-small cell lung cancer using HMFG1-99mTc monoclonal antibodies.

Anti HMFG1 monoclonal antibodies labeled with 99mTc were used for the detection of non-small cell lung cancers and their metastases in 18 patients (12 squamous cell cancers, 2 large cell lung cancers, 1 adenocarcinoma and 3 undifferentiated non-small cell lung cancer). According to performed therapy all patients were divided into three groups: group 1 consisted of 13 patients who had not received chemotherapy or radiotherapy before immunoscintigraphy (IS), group 2 included 3 patients who had undergone IS during external beam radiotherapy, and group 3 (two patients) who had received both chemotherapy and radiotherapy before IS. After antibody administration planar scintigraphy of the head and neck, chest in anterior and posterior projection, anterior abdomen, pelvis, thighs and calves was obtained at 10 minutes, 5 hours and 24 hours. The scans were interpreted semi-quantitatively using T/NT ratio. In the first group IS was found true positive in 5/13 patients (38%), and T/NT ratio ranged from 1.3-1.5. In the second group all three patients were true positive and T/NT ratio ranged from 1.76 to 2.1. In the third group both patients were found false negative. Successful metastases detection was found in 4/13 patients (30%).

Pseudomyxoma of the pleural and peritoneal cavities.

Pseudomyxoma peritonei is a rare clinical manifestation of mucin producing adenocarcinomas. An extensively metastased adenocarcinoma developed a pseudomyxoma that affected not only the peritoneal cavity but also the pleura.

[Pseudomyxoma of the pleura and peritoneum]. / Pseudomiksom pleure i peritoneuma.

A case is presented of 41 year old patient with a very rare form of clinical manifestation of adenocarcinoma with a large mucinous ascites with abdominal distention and a massive left hemithoracic content with same characteristics. Two years prior the patient suffered from acute abdomen and underwent apendectomy with slow wound healing and a stomach edema 6 months later with a finding of smaller changes on the left side of the thorax. The patient was hospitalized when he already had an advanced stage of the disease. The diagnosis of adenocarcinoma was reached with percutaneous thoracic biopsy and finding of mucinous malignant cells. Gelatinoid ascites was confirmed on CT an echography with the same finding in the thorax. Systemic chemotherapy was initiated without major effect followed by intrapleural and intraabdominal instillation of hyaluronidase in combination with cytostatics. The course of the disease and treatment effects were followed echographically and on CT. According to available literature this is the first case report of a patient with mucinous adenocarcinoma and a presentation of pseudomyxoma of the thoracic and abdominal cavities.

[Analysis of hospitalized tuberculosis patients at the Institute for Pulmonary Diseases and Tuberculosis in Belgrade, Serbia during 1988]. / Analiza hospitalizovanih tuberkuloznih bolesnika u Institutu za plucne bolesti i tuberkulozu SR Srbije u Beogradu u toku 1988. godine.

The report presents the analysis of TB patients treated at the Institute for lung diseases and tuberculosis of SR of Serbia during 1988--a total of 567 or 10.18% of discharged patients. There were 77% TB patients from Belgrade and 23% from the province. Tuberculosis retains the characteristics of a social disease with a morbidity peak in the fourth decade of age. There were 93% of cases discovered due to disease symptoms. In 82% of patients it was a case of newly discovered specific process, 7.5% had a recurrent disease and 10.5% of patients had a chronic form of the disease. The patients had almost all forms of the specific process: primary tuberculosis 0.35%, postprimary phthisis 84.4%, specific pleuritis 10.6%, tuberculom 1.9%, miliary tuberculosis 1.8%, lymphoglandular tuberculosis 0.9%, while 1.4% had extrathoracic specific lesions associated with pulmonary lesions. Cavernous tuberculosis was observed in 89% of TB patients and extensive phthisis in 14% of cases. Atypical forms of parenchymal specific process were observed in 12% patients. Bacteriological or histological confirmation of tuberculosis existed for 82%. In 13% of patients treatment lasted longer than 3 months. Six or 1% of patients died due to pulmonary tuberculosis.

[Dressler's syndrome during radiotherapy in bronchial carcinoma]. / Dresslerov sindrom u toku zracne terapije karcinoma bronha.

A case of Dressler's syndrome which has developed in a patient with bronchogenic carcinoma during radiotherapy is presented. Diagnosis is established according to symptomatology, clinical findings, chest X-ray, laboratory analysis and immunological findings. Existence of metastatic deposits in heart is excluded by the method of echocardiography. Short-term cardiologic therapy with antiflogistics is completely sufficient for maintaining the stability of "cardiologic status".

[The clinical significance of finding Pseudomonas aeruginosa in the sputum]. / Klinicki znacaj nalaza Pseudomonas aeruginosa u sputumu.

Pseudomonas aeruginosa is an ubiquitous microorganism, which is characterised with low virulence and moderately sensitive to antibiotics. Significance of identification of the bacteria in the sputum varies. In severe cases, exhausted by more simultaneous diseases, it can be manifested as a pathogenic agent. At the Institute of Pulmonary Diseases and Tuberculosis, UCC in Belgrade Pseudomonas was isolated in the sputum samples of 48 patients. The organism was apathogenic in 28 (59%) cases, in 17 (35%) cases it caused chronic suppuration, and in 3 (6%) pneumonia. No specific antipseudomonas therapy is needed in patients in good general condition, contrary to cases of manifested infection where two antibiotics, physical therapy and other measures are indicated. Basic disease determines prognosis of the infection course. Medical approach to this problem should be characterised by prevention of the infection occurrence.

[Pulmonary alveolar microlithiasis in 2 brothers]. / Microlithiase alvéolaire pulmonaire chez 2 frères.

Pulmonary alveolar microlithiasis is a rare disease of unknown cause and pathogenesis, where the pathological substrate is composed of calcium microconcrements inside the alveoli. The lungs are endured with deterioration of respiratory mechanics, ventilation and perfusion disorders and finally pulmonary hypertension and chronic cor pulmonale. The disease follows a slow course extending approximately over 20 years. The authors present two cases of pulmonary alveolar microlithiasis affecting two brothers aged 14 and 19 years respectively. Radiographic findings were typical and impressive. Lung changes were discovered on recruitment in the elder brother and on examination of family members in the younger brother. Both has no complaint and normal respiratory findings. The histopathological diagnosis was made from a sample obtained by bronchoscopic-parabronchial lung biopsy. This report is completed with data from the literature.