Lázár György

A Kupffer-sejt gátlásának hatása az endotoxin indukálta gyulladásos válaszreakciókra és a máj mikrokeringési változásaira kísérletes obstructiós icterusban * Consequences of Kupffer cell blockade on endotoxin-induced inflammatory and hepatic microcirculatory reactions during experimental biliary obstruction

INTRODUCTION/AIMS In the clinical practice, biliary obstruction often leads to septic complications causing systemic and hepatic inflammatory reactions, which increases mortality and morbidity. Hepatic Kupffer cells (KC) play a pivotal role in this process. Herein we examined the consequences of bile duct ligation during endotoxaemia and the effects of KCs. MATERIAL AND METHODS In the first part of our experiment, the survival rate of male Wistar rats in 48-hr endotoxaemia with or without bile duct ligation was assessed. Time-dependent changes in pro-inflammatory TNF-alpha and IL-6 levels were also monitored. In the second series, hepatic capillary perfusion, neutrophil-endothelial interactions and KC activity were assessed using fluorescence intravital videomicroscopy. KC blockade was induced by gadolinium chloride (GdCl3) pretreatment. RESULTS Serum TNF-alpha and IL-6 levels were significantly increased in early endotoxaemia. Survival rate was deteriorated, while TNF-alpha and IL-6 releases, KC activity and leukocyte activation were increased if obstructive jaundice was also induced. KC blockade improved survival and reduced TNF-alpha and IL-6 productions without ameliorating perfusion failure. CONCLUSIONS In the presence of biliary obstruction, inflammatory and microcirculatory consequences of endotoxaemia are enhanced. The alleviating effect of KC blockade may underline the pathophysiological role of KCs in these conditions.

Colorectalis rák májáttéteinek sebészi kezelése szinkron májreszekcióval

Metastatic liver disease is a challenging and life-threatening situation often with dismal prognosis. Nearly half of the patients with colorectal cancer develop liver metastasis during the course of their diseases. Hepatic resection is the treatment of choice in patients with colorectal liver metastasis. This study was conducted to compare the results of patients undergoing simultaneous liver and colorectal resection for synchronous liver metastasis and of those for whom a colorectal and liver resection was made separately. A retrospective analysis was performed on 1597 patients who underwent surgery because of colorectal cancer between January 1999 and December 2008. The results of the treatment were separately evaluated in case of the 152 patients who had liver metastasis. The proportion of the liver metastasis was 9.52%. The metastases arose in 40.8% from the rectum and in 31.8% from the sigmoid colon. It proved to be inoperable in 109 (71.7%) of the 152 patients who had liver metastasis. Simultaneous liver resection was performed because of synchronous metastasis in 14 (32.6%) cases (Group 1) and two step resection in 29 (67.4%) cases (Group 2). In case of synchronous operations only minor liver surgery was done. The mean size of the metastasis was 2.6 cm in diameter in Group 1 and 4.6 cm in Group 2 (p<0.005). The transfused blood volume was 0.3 U/patient. Only minor complications could be observed in Group 1. The hospitalization was 13.1 days in Group 1 and 11.7 days in Group 2. The mean survival time was 37.3 and 47.9 months (p<0.005). Simultaneous liver resection seems to be a safe procedure on those patients who develop small metastases with a limited number. However, the optimal timing of the liver resection and the identification of patients who will have the greatest benefit in survival still remain obscure.

Klinikai és hisztopatológiai eredmények előrehaladott rectumtumorok neoadjuváns kezelése után

2/nap 5-FU es 20 mg/m 2 /nap leucovorin kemoterapia, az utobbi időben kiegeszitve celzott an a makroszkopos tumorra biztonsagi zonaval 3x1,8 Gy előrehozott boost besugarzassal. Restaging vizsgalatokat kovetően atlagosan 8 hett el az onkologiai kezeles utan vegeztuk a műteteket. 38 (57%) elulső rectumreszekcio tortent kett ős stapler technikaval, 18 (27%) abdominoperinealis rectumexstirpaciot, 7 Hartmann-műtetet, illetve 4 per anum exciziot vegeztunk. A patologiai feldolgozas a preoperativ staginghez kepest 6 esetben (11%) teljes ( P T 0 N 0 ) remissziot, 43%-ban parcialis remissziot mutatott . A regresszios gradiens alapjan TRG 1 11%, TRG 2 25%, TRG 3 32,2%, TRG 4 26,8%, TRG 5 5% volt. Reoperaciot igenylő morbiditas 5,9% volt. Varratelegtelenseg nem fordult elő. Az onkologiai es sebeszi kezelesnek mortalitasa nem volt. A hosszuidejű neoadjuvans onkologiai kezeles az esetek tobbsegeben a rectumdaganat stadiumat csokkenti, ezzel emeli a reszekabilitast es a jobb eletminőseget jelentő reszekcios műtetek aranyat. Magyar Onkologia 54:129–135, 2010 Kulcsszavak: rectumcarcinoma, neoadjuvans radio-kemoterapia The role of the surgical intervention is decisive in treating colorectal tumors. The neo-adjuvant radiochemotherapy has improved the effi cacy of the treatment of advanced rectum tumors. In order to decrease the size and stage of advanced rectal carcinoma and to increase the rate of resecability, we introduced neoadjuvant radio-chemotherapy. We carried out neo-adjuvant and surgical treatment in case of 67 patients with rectal adenocarcinoma (T 2–4 N 1–2 M 0 ) between June 1, 2005 and July 31, 2008. The average age of the patients was 61.2 years, the division according to sex was 44 males/23 females. Regarding the local stage of the rectal process or the proximity to the sphincter, we applied radio-chemotherapy (radiotherapy 25 times altogether 45 Gy and on the fi rst and last week for 5–5 days they received 350 mg/m 2 / day 5-FU and 20 mg/m 2 /day leucovorin chemotherapy, recently complemented with 3x1.8 Gy advanced boost radiation aiming at the macroscopic tumor site with security zone). Patients underwent surgery 8 weeks on average aft er restaging examinations. Thirty-eight patients underwent anterior rectal resection with double stapler procedure; there were 18 abdominoperineal rectal extirpations, 7 Hartmann operations and 4 per anum excisions. Compared to the preoperative staging, the histological evaluation of the resected specimens showed total remission (pT 0 N 0 ) in 11% and partial remission in 43%. The morbidity necessitating reoperation was 5.9%, without mortality and suture insuffi ciency. The long-term neoadjuvant oncological treatment led to down-staging of rectal tumors in most cases and increased the resecability and rate of resection operations. Varga L, Baradnay G, Hőhn J, Simonka Z, Hideghety K, Maraz A, Nikolenyi A, Vereb B, Tiszlavicz L, Nemeth I, Man E, Lazar G. Clinical and histopathological results aft er the neo-adjuvant treatment of advanced rectal tumors. Hungarian Oncology 54:129–135, 2010The role of the surgical intervention is decisive in treating colorectal tumors. The neo-adjuvant radio-chemotherapy has improved the efficacy of the treatment of advanced rectum tumors. In order to decrease the size and stage of advanced rectal carcinoma and to increase the rate of resecability, we introduced neoadjuvant radio-chemotherapy. We carried out neo-adjuvant and surgical treatment in case of 67 patients with rectal adenocarcinoma (T 2-4 N 1-2 M 0 ) between June 1, 2005 and July 31, 2008. The average age of the patients was 61.2 years, the division according to sex was 44 males/23 females. Regarding the local stage of the rectal process or the proximity to the sphincter, we applied radio-chemotherapy (radiotherapy 25 times altogether 45 Gy and on the first and last week for 5-5 days they received 350 mg/m 2 /day 5-FU and 20 mg/m 2 /day leucovorin chemotherapy, recently complemented with 3 x 1.8 Gy advanced boost radiation aiming at the macroscopic tumor site with security zone). Patients underwent surgery 8 weeks on average after restaging examinations. Thirty-eight patients underwent anterior rectal resection with double stapler procedure; there were 18 abdominoperineal rectal extirpations, 7 Hartmann operations and 4 per annum excisions. Compared to the preoperative staging, the histological evaluation of the resected specimens showed total remission (pT 0 N 0 ) in 11% and partial remission in 43%. The morbidity necessitating reoperation was 5.9%, without mortality and suture insufficiency. The long-term neo-adjuvant oncological treatment led to down-staging of rectal tumors in most cases and increased the resecability and rate of resection operations.

Bal főhörgő-bifurcatio resectiója és anatómiai segmentectomia kettős granularis sejtes daganat miatt Bifurcation resection of the left mainstem bronchus and segmentectomy for double granular cell tumors

The authors report a case of a 57-year old asymptomatic patient, whose routine chest X-ray demonstrated a left-sided lung tumour. Bronchoscopy, chest CT and PET-CT revealed double granular cell tumours on the posterior wall of the distal part of the left mainstem bronchus as well as in the bronchus of the segment 6, in addition to the suspected malignant tumour in the 2nd segment. His surgical management involved the atypical resection of segment 2 lesion first, which was tuberculotic origin based on frozen section. Next, the double granular cell tumours were removed by segmentectomy of segment 6 and bifurcation resection of the mainstem bronchus. In case of granular cell tumours, resection of the mainstem bronchus is a safe procedure with good results. Further, surgical exploration is indicated in symptomatic patients with a suspicion of malignant coin lesions.