Cláudio Saddy Rodrigues Coy

Serum levels and mesenteric fat tissue expression of adiponectin and leptin in patients with Crohn's disease

Crohns disease (CD) is characterized by inflammation and an aetiology that is still unknown. Hypertrophy of mesenteric fat is a reflection of disease activity, as this fat covers the entire length of the affected area. Adipocytes synthesize leptin and adiponectin, adipocytokines responsible for pro‐ and anti‐inflammatory effects. Therefore, we evaluated serum levels of adiponectin and leptin, as well as mesenteral expression of adiponectin in active CD and those in remission. Sixteen patients with ileocaecal CD followed at the Outpatient Clinic, Coloproctology Unit of University of Campinas Clinical Hospital, participated in the study. Analysis of serum adiponectin and leptin by enzyme‐linked immunosorbent assay was performed in patients with active CD (ACD group), remission CD (RCD group) and in six healthy controls. Ten patients with active ileocaecal CD (FCD group) and eight patients with non‐inflammatory disease selected for surgery were also studied. The specimens were snap‐frozen and the expression of adiponectin was determined by immunoblot of protein extracts. Serum C‐reactive protein levels were higher in the ACD group when compared to the others and no difference of body mass index was observed between the groups. Serum adiponectin was lower in the ACD group when compared to control, but no differences were seen when comparing the ACD and RCD groups. Mesenteric adiponectin expression was lower in the FCD group when compared to the FC group. Serum leptin was similar in all groups. The lower levels of serum and mesenteric adiponectin in active CD suggest a defective regulation of anti‐inflammatory pathways in CD pathogenesis.

Comparative study of eosinophil chemotaxis, adhesion, and degranulation in vitro in ulcerative colitis and Crohn's disease

Background Eosinophils have been identified in tissues from patients with Crohns disease (CD) and ulcerative colitis (UC) but whether they contribute to IBD pathogenesis is unknown. This study aimed to investigate the functional activity and morphological aspects of peripheral‐blood eosinophils from IBD patients compared to those from healthy volunteers (HVs). Methods Eosinophils from HVs and CD and UC patients were purified using a Percoll gradient and then a immunomagnetic cell separator. Functional activity in inactivated and previously activated cells was investigated by measuring adhesion to fibronectin and chemotaxis to fMLP, and degranulation was measured by release of eosinophil peroxidase (EPO). Cell morphology was investigated using electron microscopy. Results Eosinophil adhesion to human fibronectin in both inactivated and PAF‐stimulated and PMA‐stimulated eosinophils was markedly higher in patients with CD than in either patients with UC or HVs. Similarly, the chemotactic response was markedly higher in eosinophils isolated from CD patients than in those isolated from UC patients or HVs. Baseline EPO release was higher in eosinophils isolated from UC patients than in those isolated from HVs or CD patients. Stimulation with fMLP or PMA did not further increase EPO release in cells from UC or CD patients. Comparable expression of MAC‐1 and VLA‐4 adhesion molecules was observed on the surfaces of eosinophils from all groups, and an greater number of granules was noted in the eosinophils from UC patients than in those from CD patients. Conclusions Our results indicate that peripheral‐blood eosinophils are potentially primed and activated in IBD patients. Whether the differences in the morphology and functional responses of eosinophil from UC and CD patients reflect differences in disease phenotype remains to be elucidated. (Inflamm Bowel Dis 2007)

Differential expression of pro-inflammatory cytokines and a pro-apoptotic protein in pelvic ileal pouches for ulcerative colitis and familial adenomatous polyposis

BackgroundPouchitis after total rectocolectomy is among the most common complications of patients with ulcerative colitis (UC). However, its frequency is quite rare in patients with familial adenomatous polyposis (FAP). We evaluated the inflammatory and pro-apoptotic activity in endoscopically normal mucosa of the ileal pouch in patients with UC and FAP.MethodsTwenty patients (10 with UC and 10 with FAP) with “J” pouch after total proctocolectomy were studied as were 10 normal controls. Biopsies were obtained from the mucosa of the pouch of UC and FAP patients and from the normal ileum of controls. The expression levels of TNF-α, IL-1β, IL-6, IL-8 and phospho-BAD were determined by immunoblotting. Activated NFκB was evaluated by immuno-precipitation and immunoblotting for IkappaB kinase beta.ResultsPatients with UC had higher levels of IL-1β, IL-6, IL-8 and TNF-α than patients with FAP. The level of TNF-α was higher in patients with UC than in patients with FAP; both patient groups had TNF-α levels higher than controls. Activation of NFκB was similar in all three groups. The expression of phospho-BAD was significantly lower in patients with FAP than in patients with UC.ConclusionsAs compared with patients with FAP, patients with UC presented increased levels of some pro-inflammatory cytokines, even in the absence of clinical or endoscopic signs of pouchitis. Patients with FAP presented lower levels of pro-inflammatory proteins and of phospho-BAD. These findings may explain the higher rates of progression to pouchitis in UC patients, which could correlate with mucosal atrophy that occurs in inflamed tissue.

Superior mesenteric artery syndrome as a complication of ileal pouch-anal anastomosis : report of a case

PURPOSE: Duodenal compression by the superior mesenteric artery following total proctocolectomy and ileal pouch-anal anastomosis is a rare occurrence. Previous surgical treatment involved duodenal division. The aim of this report was to describe a case with such a complication and to discuss an operative alternative. METHODS: Case report. RESULTS: Mobilization of the duodenum from its retroperitoneal attachments, without transection and reanastomosis, allowed the free passage of gas through the duodenum and recovery for the patient. CONCLUSION: This case report suggests that a more conservative approach may be successful in managing this complication.

Possible influence of glutathione S-transferase GSTT1 null genotype on age of onset of sporadic colorectal adenocarcinoma

AbstractINTRODUCTION: Glutathione S-transferase enzymes mediate exposure to cytotoxic and genotoxic agents and may be involved in cancer susceptibility. Both glutathione S-transferase mu 1 (GSTM1) and GST theta 1 (GSTT1) genes have a null variant allele in which the entire gene is absent. The association of glutathione S-transferase null genotype and risk of developing colorectal cancer is not yet fully clarified. METHODS: We tested whether the null genotypes for GSTM1 and GSTT1 genes altered the risk for sporadic colorectal adenocarcinoma in Brazilian patients. Genomic DNA from 102 sporadic colorectal adenocarcinoma patients and 300 controls was analyzed by polymerase chain reaction. RESULTS: Frequencies of GSTM1, GSTT1, and null combined genotypes were similar in patients and controls (49.9 vs. 44.6 percent, 16.6 vs. 17.3 percent, and 8.8 vs. 8 percent, respectively). We found a 1.03-fold (95 percent confidence interval, 0.96–1.10) and 1.08-fold (95 percent confidence interval, 0.99–1.18) increased risk associated with GSTM1 and GSTT1 null genotypes, respectively (P = 0.45 and P = 0.08) and a 1.18-fold (95 percent confidence interval, 0.47–2.90) increased risk associated with the combined null genotype (P = 0.74). The GSTT1 null genotype was more common in patients who were diagnosed before the age of 60 years than in those who were diagnosed at an older age (28.8 vs. 4 percent, respectively; P = 0.0008). CONCLUSIONS: The results suggest that inherited absence of this carcinogen detoxification pathway may not be associated with sporadic colorectal adenocarcinoma in the present cases. However, a higher frequency of GSTT1 null genotype in patients diagnosed before the age of 60 years suggests that this genotype could influence the age of disease onset in Brazil.

Desmoid tumor in patients with familial adenomatous polyposis

CONTEXT Desmoid tumors constitute one of the most important extraintestinal manifestations of familial adenomatous polyposis. The development of desmoids is responsible for increasing morbidity and mortality rates in cases of familial adenomatous polyposis. OBJECTIVES To evaluate the occurrence of desmoid tumors in familial adenomatous polyposis cases following prophylactic colectomy and to present patient outcome. METHODS Between 1984 and 2008, 68 patients underwent colectomy for familial adenomatous polyposis at the School of Medical Sciences Teaching Hospital, University of Campinas, SP, Brazil. Desmoid tumors were found in nine (13.2%) of these patients, who were studied retrospectively by consulting their medical charts with respect to clinical and surgical data. RESULTS Of nine patients, seven (77.8%) were submitted to laparotomy for tumor resection. Median age at the time of surgery was 33.9 years (range 22-51 years). Desmoid tumors were found in the abdominal wall in 3/9 cases (33.3%) and in an intra-abdominal site in the remaining six cases (66.7%). Median time elapsed between ileal pouch-anal anastomosis and diagnosis of desmoid tumor was 37.5 months (range 14-60 months), while the median time between colectomy with ileorectal anastomosis and diagnosis was 63.7 months (range 25-116 months). In 6/9 (66.7%) patients with desmoid tumors, the disease was either under control or there was no evidence of tumor recurrence at a follow-up visit made a mean of 63.1 months later (range 12-240 months). CONCLUSIONS Desmoid tumors were found in 13.2% of cases of familial adenomatous polyposis following colectomy; therefore, familial adenomatous polyposis patients should be followed-up and surveillance should include abdominal examination to detect signs and symptoms. Treatment options include surgery and clinical management with antiestrogens, antiinflammatory drugs or chemotherapy.

Quantificação da função esfincteriana pela medida da capacidade de sustentação da pressão de contração voluntaria do canal anal

Verificou-se que pacientes incontinentes submetidos a manometria anorretal podem apresentar pressao media de repouso e pressao maxima de contracao voluntaria dentro da faixa de normalidade. A partir da constatacao de que as medidas de pressao media de repouso e pressao maxima de contracao voluntaria (PMCV) esfincteriana nao refletem a real situacao clinica do paciente, levantou-se a hipotese de a capacidade de sustentacao da pressao de contracao (CS) seria uma medida mais correta para a avaliacao da continencia fecal, no que diz respeito a funcao de contracao esfincteriana. Foram incluidos no estudo 72 pacientes portadores de incontinencia fecal em graus variados, desde escapes ocasionais de fezes e de gases ate incontinencia franca a fezes solidas, e 15 individuos normais, escolhidos, aleatoriamente, entre os pacientes encaminhados devido a outras queixas ou situacoes, como: proctalgia, prurido anal, pre-operatorio de reconstrucao de trânsito intestinal e pre-operatorio de cirurgia de coluna lombossacra. Todos os individuos normais nao apresentavam queixas de incontinencia fecal de qualquer grau. Os pacientes incontinentes e os individuos normais foram submetidos a manometria anorretal onde foram analisados os seguintes parâmetros: pressao media de repouso (PMR), pressao maxima de contracao voluntaria (PMCV), capacidade de sustentacao da pressao de contracao voluntaria (CS) . Entre os pacientes incontinentes, 39(54%) apresentaram niveis normais de PMCV e 33(46%) PMCV abaixo do normal; e todos os individuos normais apresentaram PMCV em nivel normal. Em relacao a CS, verificou-se que 56(78%) dos pacientes incontinentes apresentaram capacidade inadequada. A medida da PMCV apresentou excelente especificidade (100%), porem, baixa sensibilidade (46%) para incontinencia fecal. Comparativamente, a medida da CS apresentou alta especificidade (93%) e alta sensibilidade (78%) para incontinencia fecal. Alem disso, a medida da PMCV nao indicou falso positivo (PF+ = 0), mas, em compensacao, apresentou 72% de falso negativo. A probabilidade deste fato ocorrer com a medida da CS foi, praticamente, 20% menor, valor estatisticamente significante. Concluindo, a medida da CS e um bom indicativo da funcao esfincteriana do canal anal em relacao a continencia fecal Abstract

Prototype system for feature extraction, classification and study of medical images

MIAS 3.0 supports automatic feature extraction and medical image classification.The system was developed according to prototyping, a software engineering approach.Experts found that MIAS 3.0 meets the proposed requirements and is a promising tool.MIAS 3.0 experimental evaluation was conducted in 67 image fragments.A J48 classifier built from Amadasun and Haralick features was the best MIAS setting. Colonoscopy exam images are useful to identify diseases, such as the colorectal cancer, which is one of the most common cancers worldwide. Computational image analysis and machine learning techniques can assist experts to identify abnormalities in these images. In this work, we present and evaluate MIAS 3.0, which aims to help experts to study and analyze colon tissue images. To do so, the system initially extracts features from these images. Currently, Amadasum, Haralick and Laws texture descriptors are supported. Then, the described images are classified into normal or abnormal images. In this version, J48, nearest neighbor, backpropagation based on multilayer perceptron, naive Bayes, and support vector machine classification algorithms are implemented. MIAS was developed with open source technologies using a software engineering approach to improve flexibility and maintainability. In this work, MIAS was quantitatively assessed by its application in a set of 134 tissue image fragments. The classifiers built from this set were compared according to the cross-validation and contingency table strategies. Also, the system was qualitatively evaluated using 12 heuristics by twelve volunteers from Health and Exact Sciences. The issues found were categorized according to Rolf Molichs severity scale. As a result, the J48 classifier achieved the highest sensitivity (85.07%) and reasonable average error (18.68%). In the qualitative evaluation, 61.26% of the issues found were not considered serious. These assessments suggest that MIAS can be useful to assist domain experts with minimum knowledge in informatics to conduct more complete studies of medical images, by identifying patterns regarding different abnormalities.

Activation of signal transducer and activator of transcription-1 (STAT-1) and differential expression of interferon-γ and anti-inflammatory proteins in pelvic ileal pouches for ulcerative colitis and familial adenomatous polyposis

Pouchitis after total rectocolectomy is the most common complication of ulcerative colitis (UC). The immunological mechanisms involved in the genesis of pouchitis are unclear. Therefore, we evaluated the inflammatory activity in normal ileal pouch mucosa by determining signal transducers and activators of transcription (STAT‐1) activation and cytokine expression in patients operated for UC and familial adenomatous polyposis (FAP). Eighteen asymptomatic patients, who underwent total rectocolectomy and J pouch, were evaluated: nine with UC and nine with FAP. The activation of STAT‐1 and cytokine expression were determined by immunoblot of total protein extracts from pouch mucosal biopsies. The absence of pouchitis was assessed by clinical, histological and endoscopic parameters, according to the Pouchitis Disease Activity Index. The patients were not receiving any medication. Analysis of variance (anova) and Tukey–Kramers test were applied. The local ethical committee approved the study and informed consent was signed by all participants. STAT‐1 activation was increased in UC when compared to FAP and controls (P < 0·05). Higher levels of interferon (IFN)‐γ expression were observed in UC patients when compared to the control group (P < 0·05), but were similar to FAP. In contrast, cytokine signalling (SOCS‐3) and interleukin (IL)‐10 expression were similar in all groups (P > 0·05). These findings could explain the higher susceptibility to this inflammatory complication in UC when compared to FAP. A tendency towards increased levels of IFN‐γ and STAT‐1 in patients with UC, even without clinical and endoscopic evidence of pouchitis, was observed; studying inflammatory activity in asymptomatic ileal pouches may help understanding of the pathogenesis of pouchitis.

Extragastrointestinal Stromal Tumor and Liver Transplantation : Case Report and Review

The occurrence of de novo malignant neoplasias has been shown in postransplant patients under imunosuppression. It is the second leading cause of late death in liver transplant recipients. The greatest incidence is seen in cancers associated with chronic infection by human papilloma virus, skin cancers, oropharyngeal, and gastrointestinal (GI) malignancies. GI stromal tumors (GISTs) are the most common mesenchymal tumors of the GI tract. Rare cases are identified outside the GI tract are collectively known as extragastrointestinal stromal tumors (EGISTs). We present an EGIST case in a liver transplantation patient. A 64-year-old man underwent liver transplantation because of cirrhosis (hepatitis B virus and alcoholism) and hepatocellular carcinoma. Histopathologic findings revealed 2 trabecular hepatocellular carcinomas: a 3.5-cm-diameter lesion located at segment VIII and another 2-cm one at segment V. Seven months later, he noticed a hardened, mobile, painless, 3-cm subcutaneous nodule in the perineum localized in the right lateral quadrant 2 cm distant from the anus. A surgical resection with 1 cm margin yielded a histopathology report of a 5.0 x 3.0 cm spindle cell stromal tumor. The immunohistochemical profile was compatible with a GIST, with 5 mitosis per 50 high-powered fields. This tumor is extremely rare after liver transplantation but has shown a good outcome up to now.