Maciej Słupski

Local recurrence and distant metastases 18 years after resection of the greater omentum hemangiopericytoma

BackgroundHemangiopericytoma occurs with increasing frequency in 5th decade of life and has prediction for retroperitoneum and extremities. A case of a local recurrence and metastases of hemangiopericytoma is described.Case presentationRecurrence of hemangiopericytoma in the greater omentum and the jejunal mesentery as well as metastases in the retroperitoneal space were diagnosed in a 61-year-old patient who had a hemangiopericytoma of the greater omentum excised 18 years before.ConclusionBecause of the rarity of this disease and its typical clinical course associated with late recurrence and metastases, the authors decided to present this case emphasizing the necessity of systematic oncological follow-up after the end of treatment.

Unexpected response to systemic chemotherapy in case of primarily nonresectable advanced disseminated intrahepatic cholangiocarcinoma

BackgroundCholangiocellular cancers account for about 10-15% of primary liver cancers. Prognosis is poor, with expected survival of less than 5% at five-year.Case presentationThe case described shows remission of a disseminated cholangiocellular carcinoma (focal changes in liver, metastases to lungs) after neoadjuvant chemotherapy. The initial diagnosis was based on ultrasound examination and confirmed with computer tomography. Tumour biopsy and histopathological examination revealed cholangiocellular carcinoma. The patient underwent chemotherapy. After remission of lesions in lungs and reduction/regression of tumours in liver to one focal change, right lobe liver resection was performed. The histopathological examination did not reveal any viable carcinoma cells, only necrotic tissues in place of the primary tumour as well as in local portal vein branches was seen. Thirty months after the operation the patient is in a good overall condition and no recurrence has been observed.ConclusionAppropriate neoadjuvant chemotherapy may allow radical resection in a previously unresectable cholangiocellular cancer.

Cyclosporine-A, but not tacrolimus significantly increases reactivity of vascular smooth muscle cells

BACKGROUND Application of cyclosporine-A (CsA) or tacrolimus is associated with numerous side effects. One of the main reasons for restricting usage of CsA is hypertension. In tacrolimus treated subjects the frequency of these phenomena is significantly lower. The known molecular mechanism of action of tacrolimus and cyclosporine-A seems to be the same, thus we decided to compare modulatory effect of drugs on vascular smooth muscle contractility. METHODS Experiments were performed on isolated and perfused tail artery of Wistar rats. Contraction force was measured by increased degree of perfusion pressure with a constant flow rate. RESULTS Concentration-response curves for agonist in the presence CsA were significantly shifted to the left with increase in maximal responses. This effect was due to increased calcium influx from extracellular calcium stores whereas there were no significant changes in calcium influx in the presence of tacrolimus; concentration-response curve was comparable to controls. CONCLUSION Our results strongly support the idea that main difference between effects on smooth muscle contractility of calcineurin-dependent immunosuppressants: CsA and tacrolimus is related to the different level of extracellular calcium influx to the cytoplasm. The elucidation of these mechanisms may permit the identification of new therapeutic strategies against CsA-induced hypertension.

A brain dead woman, giving birth in the 23rd week of pregnancy, used as an organ donor: A case report

BACKGROUND Maternal brain death during pregnancy is an exceptional case when somatic support might be continued despite diagnosed death. There are only a few cases of maternal brain death during pregnancy reported in the literature and detailed data regarding the frequency of such cases are lacking. CASE REPORT The case of a 40-year-old woman, diagnosed brain dead due to a subarachnoid and intracranial hemorrhage in the 21st week of pregnancy is presented. The patient was admitted to the neurosurgery department and then to the intensive care unit, where brain death was diagnosed. The medical team decided to perform a caesarean section, and a living female infant was delivered. After delivery, maternal kidneys were recovered and successfully transplanted. CONCLUSIONS This challenging case indicates that prompt diagnosis of maternal brain death is required to facilitate decision-making regarding somatic support prolongation to save the life of the fetus, as well as to allow procurement of the maternal organs.

The Role of the Endothelium in the Regulation of Vascular Smooth Muscle Cell Contractions Induced by Angiotensin II after Ischemia and Reperfusion

In this study, we investigated smooth muscle cell contractions induced by angiotensin II (ANG II) in blood vessels with or without endothelium after ischemia/reperfusion. Experiments were done on tail arteries, with or without endothelium, of perfused male Wistar rats. We analyzed the influence of ANG II on vascular contractions in the presence of sodium nitroprusside or 8Br-cGMP and after ischemia/reperfusion using classical pharmacometric methods. Vascular contractions induced by ANG II were decreased by sodium nitroprusside and 8BrcGMP. Reductions in maximal response and increases in EC50 values after ischemia were observed only in vessels with endothelium. After reperfusion, increases in maximal response and decreases in EC50 values were observed. Decreases in ANG II induced vascular contractions on caused by ischemia involves the presence of endothelium, synthesis of nitric oxide and activation of cGMP. The increase in the reaction to ANG II that is induced by reperfusion is independent of the endothelium.

Surgical treatment of recurrent urachal carcinoma with liver metastasis: a case report and literature review

BackgroundUrachal carcinoma is a rare malignancy with poor prognosis due to late presentation of the disease and its aggressiveness. Surgery remains the mainstay of therapy even in cases of disease recurrence. To the best of our knowledge, this is the first report of salvage surgery in the case of urachal carcinoma with liver metastasis.Case presentationThe patient was a young woman who suffered from locally advanced urachal carcinoma treated with en-bloc cystectomy, hysterectomy with bilateral adnexectomy, partial resection of the sigmoid colon, and partial resection of the rectus abdominis muscle with the fascia, skin, and umbilicus. Adjuvant chemotherapy with paclitaxel and carboplatin was applied. Two years after the treatment, she was diagnosed with a single liver metastasis and a local pelvic recurrence. In a two-step operation, the patient underwent right hemihepatectomy as well as resection of pelvic recurrence site and adjuvant chemotherapy with gemcitabine. Due to the disease progression, a complete resection of the lesions was not achieved and the response to chemotherapy was poor. The patient died of the disease after a year.ConclusionsSurgery is the first line of treatment for urachal carcinoma and should be always considered as an option in cases of disease recurrence. Radical initial surgical management, close patient surveillance, and prompt treatment of disease relapse may all contribute to prolonging patient’s survival.

Modulation of the Reaction of Vascular Smooth Muscle Cells to Angiotensin II Induced by Catalase and Aminotriasol During Ischemia–Reperfusion

BACKGROUND We investigated the influence of catalase and aminotriasol on reactions of the smooth muscle cells induced by angiotensin II (ANG II) after ischemia-reperfusion (I/R). MATERIALS AND METHODS Experiments were performed on perfused male Wistar rat tail arteries. Using classical pharmacometric methods we analyzed the influence of ANG II on vascular contraction, in the presence of catalase and aminotriazole, and after I/R. RESULTS A reduction in maximal response and increased EC(5) value were observed after ischemia, while an increased maximal response and decrease EC(50) value were observed after reperfusion. Catalase decreased and aminotriasol increased maximal responses to ANG II. In the presence of catalase, reduction of the maximal response and increase in EC(50) value were observed after reperfusion. In the presence of aminotriasol, we observed increased maximal response and decreased EC(50) value after I/R. CONCLUSION Ischemia reduced and reperfusion increased the responses of vascular smooth muscle cells to ANG II. Catalase decreased and aminotriasol increased hyperreactivity of arteries to ANG II after reperfusion. These results suggested that antioxidative system modulates reactions induced by ANG II. Reperfusion impairs the balance between antioxidants and the production of reactive oxygen species.

Noninvasive evaluation of renal tissue oxygenation with blood oxygen level-dependent magnetic resonance imaging early after transplantation has a limited predictive value for the delayed graft function

Purpose The aim of this study was to evaluate the feasibility of renal oxygenation assessment using blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) in the early period after kidney transplantation and to estimate its prognostic value for delayed graft function. Material and methods Examinations were performed in 50 subjects: 40 patients within a week after the kidney transplantation and 10 healthy controls, using T2*-weighted sequence. Measurements in transplant patients were correlated to basic laboratory parameters in the early period after transplantation and at follow-up. Results Examinations of seven patients (18%) were rejected due to their poor technical quality. Mean R2* values in transplant recipients were lower than in controls (11.6 vs. 15.9 Hz; p = 0.0001). An R2* value of 0.28 Hz was calculated as the minimal detectable change. There was no relation between R2* values and laboratory parameters. However, patients eGFR ≥ 40 ml/min/1.73 m2 presented higher R2* values than recipients eGFR < 40 ml/min/1.73 m2 (12.0 vs. 11.1 Hz; p = 0.0189). In ROC analysis R2* of ≤ 11.7 predicted an early reduced graft function with 0.82 sensitivity and 56% specificity (AUC = 0.708; p = 0.024) but was not useful for delayed graft function prediction (p > 0.7). Conclusions Evaluation of renal graft oxygenation using BOLD MRI is technically challenging in the early period after transplantation. An R2* value of 0.28 Hz may in practice be considered as the minimal detectable change. The delayed graft function seems not to be dependent on early oxygenation values. Further, large-scale studies are necessary to confirm the latter observation.

Activity of metalloproteinases and adiponectin in obese patients— a possible factor of incisional hernias after bariatric procedures

PurposeMetalloproteinases are a key component of the pathogenesis of abdominal hernias. Obesity is considered a risk factor in herniogenesis and hernia recurrence. The aim of this study was to evaluate the serum concentrations of metalloproteinase-2 (MMP-2), MMP-9, MMP-13, and adiponectin in morbidly obese and nonoverweight controls.Materials and methodsThe participants were recruited from among patients undergoing bariatric and non-bariatric surgery and divided into two groups: I (body mass index (BMI)≥35 kg/m2, n=40) and II (BMI<25 kg/m2, n=30). Serum concentrations of MMP-2, MMP-9, MMP-13, and adiponectin were measured using enzyme-linked immunosorbent assay (ELISA).ResultsA statistically significant difference between groups was observed for MMP-2 concentration. The median MMP-9 concentration was higher in the obese group, but the difference was not statistically significant. Median MMP-13 concentrations did not differ between groups. Serum adiponectin concentration was insignificantly higher in the non-obese group.ConclusionsThe elevated serum MMP-2 and MMP-9 concentrations in obese individuals may be related to the higher incidence of incisional hernias in this population.摘要目的主要研究病态肥胖患者与正常人血清中金属蛋白 酶2(MMP-2)、MMP-9、MMP-13 和脂联素的 浓度。创新点建立血清中MMP-2、MMP-9、MMP-13 和脂联 素的浓度与肥胖和切口疝的关系。方法参与实验的人员为进行肥胖手术的患者和不进行 肥胖手术的患者,并将他们分为两组:I(体重 指数(BMI)≥35 kg/m2,n=40)和II (BMIlt;25 kg/m2, n=30),并使用酶联免疫吸附实验测定受试人员 体内血清中MMP-2、MMP-9、MMP-13 和脂联 素的浓度。结论MMP-2 的浓度在肥胖组中更高,且在两组血清 中有显著性差异。虽然MMP-9 的浓度在肥胖组 中更高,但是两组之间没有显著性差异。MMP-13 在两组间没有差异。血清中脂联素的浓度在非肥 胖组更高,但无显著性差异。因此,血清中 MMP-2和MMP-9的浓度在肥胖人群中与更高的 切口疝发病率有关。

Neuroprotective Activity of Sitagliptin via Reduction of Neuroinflammation beyond the Incretin Effect: Focus on Alzheimer’s Disease

Sitagliptin is a member of a class of drugs that inhibit dipeptidyl peptidase (DPP-4). It increases the levels of the active form of incretins such as GLP-1 (glucagon-like peptide-1) or GIP (gastric inhibitory polypeptide) and by their means positively affects glucose metabolism. It is successfully applied in the treatment of diabetes mellitus type 2. The most recent scientific reports suggest beneficial effect of sitagliptin on diseases in which neuron damage occurs. Result of experimental studies may indicate a reducing influence of sitagliptin on inflammatory response within encephalon area. Sitagliptin decreased the levels of proinflammatory factors: TNF-α (tumor necrosis factor-α), IL-6 (interleukin-6), IL-17 (interleukin-17), and CD-163 (cluster of differentiation 163), and contributed to an increase in levels of anti-inflammatory factors: IL-10 (interleukin-10) and TGF-β (transforming growth factor β). Moreover, sitagliptin demonstrated antioxidative and antiapoptotic properties by modifying glutamate and glutathione levels within the region of hippocampus in mice. It has been observed that sitagliptin decreases accumulation of β-amyloid within encephalon structures in experimental models of Alzheimers dementia. This effect may be connected with SDF-1α (stromal cell-derived factor 1α) concentration. Administration of sitagliptin caused a significant improvement in MMSE (Mini–Mental State Examination) tests used for assessment of dementias. The paper presents potential mechanisms of sitagliptin activity in conditions connected with neuroinflammation with special emphasis on Alzheimers disease.