Jerzy Lubikowski

An intensified systemic trafficking of bone marrow‐derived stem/progenitor cells in patients with pancreatic cancer

Various experimental studies indicate potential involvement of bone marrow (BM)‐derived stem cells (SCs) in malignancy development and progression. In this study, we comprehensively analysed systemic trafficking of various populations of BM‐derived SCs (BMSCs), i.e., mesenchymal, haematopoietic, endothelial stem/progenitor cells (MSCs, HSCs, EPCs respectively), and of recently discovered population of very small embryonic/epiblast‐like SCs (VSELs) in pancreatic cancer patients. Circulating CD133+/Lin−/CD45−/CD34+ cells enriched for HSCs, CD105+/STRO‐1+/CD45− cells enriched for MSCs, CD34+/KDR+/CD31+/CD45− cells enriched for EPCs and small CXCR4+CD34+CD133+ subsets of Lin−CD45− cells that correspond to VSELs were enumerated and sorted from blood samples derived from 29 patients with pancreatic cancer, and 19 healthy controls. In addition, plasma levels of stromal‐derived factor‐1 (SDF‐1), growth/inhibitory factors and sphingosine‐1‐phosphate (S1P; chemoattractants for SCs), as well as, of complement cascade (CC) molecules (C3a, C5a and C5b‐9/membrane attack complex – MAC) were measured. Higher numbers of circulating VSELs and MSCs were detected in pancreatic cancer patients (P < 0.05 and 0.01 respectively). This trafficking of BMSCs was associated with significantly elevated C5a (P < 0.05) and C5b‐9/MAC (P < 0.005) levels together with S1P concentrations detected in plasma of cancer patients, and seemed to be executed in a SDF‐1 independent manner. In conclusion, we demonstrated that in patients with pancreatic cancer, intensified peripheral trafficking of selected populations of BMSCs occurs. This phenomenon seems to correlate with systemic activation of the CC, hepatocyte growth factor and S1P levels. In contrast to previous studies, we demonstrate herein that systemic SDF‐1 levels do not seem to be linked with increased mobilization of stem cells in patients with pancreatic cancer.

Liver transplantation as an ultimate step in the management of iatrogenic bile duct injury complicated by secondary biliary cirrhosis.

BACKGROUND This report summarizes a single centers experience with liver transplantation (LT) performed for secondary biliary cirrhosis resulting from iatrogenic bile duct injury (BDI) sustained during cholecystectomy. MATERIAL/METHODS Secondary biliary cirrhosis was the indication for LT in 5 (1.7%) out of 300 LTs performed in our center between Feb 2002 and April 2011. We analyzed the medical history of the patients, perioperative course and outcome following LT. RESULTS The BDI was classified as Strasberg A in 1 case, B in two cases, and E in 2 cases. There was no hepatic arterial or portal vein injury in any patient. All of the surgical repairs prior to the development of cirrhosis were performed in general surgical units. The median time between BDI and listing the patient for LT was 11 years. The cadaveric whole-organ LT was done in all patients using the Piggy-Back technique. All patients are alive with a median follow-up of 53 months. CONCLUSIONS Liver transplantation in patients with secondary biliary cirrhosis appears to result from a series of inadequate multiple surgical repairs following BDI. The immediate referral of such patients to centers with bile duct surgery experience is crucial.

Aggressive surgical management of recurrent lymph node and pancreatic head metastases of resected fibrolamellar hepatocellular carcinoma: a case report.

CONTEXT Fibrolamellar hepatocellular carcinoma is a rare liver tumor with the propensity to metastasize to the lymph nodes months or years after initial surgery. However, its metastatic spread to the pancreas was previously reported only in a child. CASE REPORT We present an unusual case of a young female patient who was repeatedly treated by surgical excision of abdominal and mediastinal lymph node recurrences between 2 and 6 years after left hepatic lobectomy for fibrolamellar hepatocellular carcinoma. At 8 years following her initial surgery, the patient was diagnosed with pancreatic head metastasis and a pancreaticoduodenectomy was performed. Postoperative course was uneventful and the patient did not experience recurrence within the last 18 months. CONCLUSION The metastasis of fibrolamellar hepatocellular carcinoma to the pancreas is highly exceptional but possible and its excision appears warranted as well.

Usefulness of 13C-methacetin breath test in liver function testing in Amanita phalloides poisoning; breast feeding woman case

Introduction. Mortality from ingestion of the mushroom Amanita phalloides still remains as high as 8–10%. In critical patients, liver dialysis can bridge the patient to liver transplantation, which may be a lifesaving procedure. We report the use of 13C-methacetin breath test (13C-MBT) in monitoring hepatic function in a case of A. phalloides poisoning. Case report. A 33-year-old woman ate mushrooms that she had picked. After 8 h, she developed nausea and vomiting, abdominal cramps, and diarrhea, which lasted for another 24 h. On the third day, features of liver injury were seen. Pharmacologic therapy failed and she underwent liver dialysis on days 4 and 5. A 13C-MBT was used to evaluate hepatic functional reserve before the first and after the second dialysis. A liver transplantation on day 6 was successful. Discussion. The breath test results showed that at 40 min after substrate ingestion the mean 13C-MBT cumulative oxidation percentage was 10.5 ± 3.8% in healthy controls, whereas in our patient this parameter decreased from 0.09% on the fourth day to 0.02% on the fifth day. Conclusions. 13C-MBT is a simple, non-invasive diagnostic tool which may be useful as a predictor of outcome and as a marker of the severity of liver damage.

Direct pressure measurement in the hepatic artery during liver transplantation: can it prevent the "steal" syndrome?

Wojcicki M, Pakosz‐Golanowska M, Lubikowski J, Post M, Jarosz K, Milkiewicz P. Direct pressure measurement in the hepatic artery during liver transplantation: can it prevent the “steal” syndrome? 
Clin Transplant 2011 DOI: 10.1111/j.1399‐0012.2011.01478.x. 
© 2011 John Wiley & Sons A/S.

Pancreatoduodenectomy with a modified duct-to-mucosa pancreaticojejunostomy: an analysis of 101 consecutive patients.

BACKGROUND/AIMS The aim of the study was to analyze in-hospital morbidity and mortality after pancreatoduodenectomy (PD) with a modified duct-to-mucosa pancreaticojejunostomy. METHODOLOGY We retrospectively analyzed 101 consecutive patients who underwent PD at our center between January 2002 and December 2010. Two-layered duct-to-mucosa pancreaticojejunostomy was performed over an internal transanastomotic stent in all patients. RESULTS The overall in-hospital morbidity and mortality rate was 48% and 6%, respectively. Three patients died as a consequence of local complications including mesenteric ischemia in two and acute necrotizing pancreatitis in one case. Pancreatic fistula occurred in one (1%) patient and was treated conservatively with good outcome. The wound infection was the most common surgical complication (20/101; 20%) and occurred more often in patients who had a biliary stent inserted endoscopically prior to surgery (15/38; 39%), as compared to those without the stent (5/63; 8%; p=0.0003). CONCLUSIONS The results of the present study suggest that a two-layered duct-to-mucosa pancreaticojejunostomy with internal transanastomotic stent is a safe anastomosis, associated with a very low risk of pancreatic fistula. The presence of a biliary stent at the time of surgery represents a risk factor for the development of postoperative wound infection.

Mesenteric location of a perforated Meckel's diverticulum in an elderly patient with acute appendicitis: a case report

A 70-year-old male patient presented to the emergency department with signs of local peritonitis at the right lower abdomen after initial upper abdominal pain throughout two previous days. His basic vital parameters were normal while laboratory tests showed C-reactive protein of 60 mg/L (normal range: 0–5 mg/L) and serum leucocytes within normal range (5.9 × 10/μL). Contrast-enhanced computed tomography scan revealed thickening of the distal part of the ileum (Fig. 1a) and diverticular disease of the sigmoid colon (Fig. 1b), accompanied by some free air under the right diaphragm (Fig. 1c) and intraperitoneal fluid (Fig. 1d). A perforated sigmoid diverticulum