Cytokine gene polymorphisms and high-resolution-computed tomography score in idiopathic pulmonary fibrosis.

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a serious disease with unknown cause and the influence of cytokine gene polymorphisms is presumed in the etiology and pathogenesis of the disease. We used high-resolution computed tomography (HRCT) as a marker of disease stage and progression and compared the alveolar and interstitial score with IL-1, IL-4, IL-12, IL-1RA and IL-4RA cytokine gene polymorphisms. SUBJECTS AND METHODS: The IPF patients were all Caucasians from the Czech Republic and consisted of 20 females and 10 males, with a mean age of 65 years, range 36-85. The HRCT results were evaluated by an experienced viewer using the interstitial and alveolar score scales, which were based on the IPF HRCT description system from Gay SE, Kazerooni EA, Tows GB, Lynch JP, Gross BH, Cascade PN, et al. [Idiopathic pulmonary fibrosis. Predicting response to therapy and survival. Am J Respir Crit Care Med 1998;157:1063-72]. We evaluated the polymorphisms of cytokine genes utilizing a PCR with sequence-specific primers method. RESULTS: The HRCT alveolar score was more pronounced in IL-4 RA (+1902) AG heterozygotes. The HRCT interstitial score was less severe in the IL-12 (-1188) AA homozygotes. According to progression of the HRCT interstitial score, the CC homozygosity at IL-1 RA (mspa 111100), the AA homozygosity at IL-4 RA (+1902) and CC homozygosity at IL-4(+33) positions were more frequent in patients with stable disease compared to those with progressive disease. CONCLUSIONS: We assume from our data that the polymorphisms of IL-4, IL-4RA, IL-1RA and IL-12 genes (genes of cytokines with regulatory activity) might influence the phenotype of IPF as shown by measurable changes in HRCT investigations.

Computed tomography-guided anterior approach to the superior hypogastric plexus for noncancer pelvic pain: a report of two cases.

The objective of this study was to evaluate the possibility and describe the methodology of a computed tomography-guided anterior approach to superior hypogastric plexus block for noncancer pain. A computed tomography-guided anterior approach to the superior hypogastric plexus was used in 2 patients with pelvic pain and anatomic disturbance of the lumbar spine, which was a contraindication to the conventional dorsal approach. The first case was a 43-year-old patient suffering from burning pain of the urethra. Pain relief using analgesics and antidepressants was insufficient. The posterior approach was excluded due to coexisting irritation of the L5 nerve root. The second case was a 68-year-old man suffering from chronic burning and itching pain of the urethra and glans penis. Conservative therapy (anti-inflammatory drugs, tramadol, spasmolytics) failed to provide satisfactory pain relief. The posterior approach was contraindicated because of laterally prominent L5 vertebral body osteophytes. Both patients received a prognostic block to the superior hypogastric plexus via the anterior approach guided by computed tomography. Visual analog scale scores prior to the block were 6 to 7 and 5 to 6, respectively. The visual analog scale scores 24 hours after the block were 1 and 0, respectively. The second patient received a permanent neurolytic block via the anterior approach to provide long-term pain relief. In conclusion, the authors describe the computed tomography-guided anterior approach to the superior hypogastric plexus for chronic pelvic pain. The technique is simple to perform, and the analgesic effect is satisfactory. More extensive studies are necessary to evaluate the safety of this approach.

Mesohepatectomy for colorectal liver metastasis. Case report.

A 54-year-old woman was operated for obstructive ileus in 1996. Obstruction was caused by a tumor of the descending colon invading the abdominal wall. Urgent left colectomy with lymphadenectomy was performed. Microscopically six lymphatic nodes were positive. The patient was postoperatively treated with adjuvant chemotherapy. Fifteen months later the patient underwent a resection of central hepatic segments (Couinaud's segment 4,5,8) for metachronous metastasis. At present the patient has no signs of recurrence, she has returned back to her normal life. Despite several unfavorable prognostic factors--obstruction, abdominal wall infiltration, number of positive nodes, short time between primary tumor resection and diagnosis of liver metastasis and centrally located metastasis with satellite lesions, the patient has been surviving for 6 years now.