Milosz Jasinski

Can We Rely on PET in the Follow-Up of Advanced Seminoma Patients?

The management of residuals after completion of chemotherapy in advanced seminoma is controversial. It has been proposed that fluorodeoxyglucose-positron emission tomography (FDG-PET) can be used as a follow-up. In this study we investigated FDG-PET as a follow-up tool in advanced seminoma patients treated previously with chemotherapy or radiotherapy. Thirty-seven patients assigned to an advanced seminoma group based on CT and/or FDG-PET/CT and then treated with chemotherapy were included in the study. All these patients underwent FDG-PET/CT examination as a part of the follow-up scheme. Patients underwent retroperitoneal lymph node dissection (RPLND), radiotherapy, or were followed clinically by CT and/or PET/CT every 6 months. In 8 cases FDG-PET was positive: 5 of them underwent RPLND and 3 radiotherapy. Two patients with negative FDG-PET but positive CT also underwent RPLND. The remaining patients with negative FDG-PET results were followed up. FDG-PET/CT was false positive in one case >3 cm and one <3 cm, in 6 cases >3 cm it was true negative. While FDG-PET can find a viable tumor, there also is an important question of false positive results. It was clinically proven that a negative FDG-PET was correlated with stable disease, but we were unable to examine specimens in these cases.

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.

Lymph node dissection during laparoscopic (LRC) and open (ORC) radical cystectomy due to muscle invasive bladder urothelial cancer (pT2-3, TCC)

Aim The aim of the study was to compare the number of nodes dissected during laparoscopic and open radical cystoprostatectomy in men or anterior exenteration in women due to muscle invasive bladder urothelial cancer (IBC). Material and methods Fifty-one patients treated with laparoscopic radical cystectomy (LRC) and 63 with open radical cystectomy (ORC) were compared. The LRC group consisted of 47 pT2 tumours and 4 pT3, while the ORC group was composed of 27 pT2 tumours and 36 pT3. During ORC external, internal, common iliac and obturator lymph nodes were removed separately, but were added and analysed together for each side. Nodes dissected from one side during ORC were compared to en bloc dissected nodes in the LRC group. Results There were no complications associated with extended pelvic lymph node dissection during LRC or ORC. There were significant differences in the mean number of resected lymph nodes between LRC and ORC for pT2 tumours. The laparoscopic approach allowed about 8-9 more lymph nodes to be removed than open surgery in the pT2 group. In 15% of patients with pT2 disease treated with open radical cystectomy node metastases were observed. Active disease was detected in 18% of nodes resected laparoscopically due to pT2 disease. Fourty-seven percentage of patients with pT3 disease treated with open surgery were diagnosed as harbouring metastatic lymph nodes. The laparoscopic group with pT3 disease was too small to analyse. Conclusions We have found that laparoscopic radical cystectomy can be performed without any compromise in lymph node dissection. The technique of lymph node dissection (LND) during laparoscopic cystectomy (LRC) resulted in sufficient resected lymphatic tissue, especially in patients with bladder-confined tumours with a low volume of lymph nodes.

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.

Radiofrequency ablation of small renal masses as an alternative to nephron-sparing surgery: preliminary results.

Introduction Radical endoscopic minimal-invasive treatment methods, such as thermal ablation, are sought as an alternative to standard radical surgical treatment of kidney neoplasms. We analysed patients who could be qualified for radical treatment due to T1a renal tumour. Material and methods Twenty-three patients out of 129 who underwent radiofrequency thermal ablation of kidney tumours in the years 2003-2010 were analysed. The inclusion criteria were age below 70 years, lack of major comorbidities (ASA score 1, 2), and competent contralateral kidney. In all cases tumour size was below 4 cm. All patients were followed up with computed tomography (CT) and ultrasonography (USG) every 6 months for 3 years. Results In 20 patients kidney tumour was biopsied before radiofrequency ablation (RFA) and 10 of these biopsies were positive and revealed cancer. Six patients required additional treatment due to recurrence visible in CT – 3 with a positive biopsy result, 1 with negative and 2 without biopsy. Three of them were treated with a second session of RFA, 1 with radical nephrectomy and 2 with partial nephrectomy. No disease dissemination was observed and all patients who received additional treatment remain disease free. Conclusions The RFA can be safely used in selected patients with T1a tumour as an alternative to partial nephrectomy. Careful follow-up is required after thermal ablation and allows early detection and successful treatment of recurrences.

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.

Radiofrequency ablation of small renal masses in comorbid patients

Introduction Over the recent years, the progress in imaging techniques has led to increased detection of small renal masses (SRMs), including in elderly and high-risk patients. Partial nephrectomy (nephron-sparing surgery – NSS), the current standard of care in T1a kidney tumours, has some limitations in patients who are poor candidates for surgery, as it is associated with potential perioperative complications and possible renal function loss. Radiofrequency ablation (RFA), a minimally invasive method that can be performed percutaneously, is an option in such cases. Aim To present our experience in treatment of SRMs using RFA in comorbid patients. Material and methods In the years 2006–2012, 103 percutaneous, ultrasound-guided RFA procedures were performed in the Oncology Centre in Bydgoszcz in patients with an ASA score ≥ 3. Abdominal computed tomography and tumour biopsy were performed before the procedure. The average follow-up time was 46 months. Results The 1, 3 and 5-year overall survival rates were respectively 97%, 90% and 75%, while cancer-specific survival was 100%. No Clavien-Dindo grade ≥ 3 complications were observed. Conclusions Radiofrequency ablation performed percutaneously is a minimally invasive treatment and may be applied in patients who are, due to comorbidities, poor candidates for surgery. In comorbid patients, where other causes of death play an important role, the application of a minimally invasive treatment method with satisfactory oncological effectiveness is justified.

Rho-kinase inhibitor reduces hypersensitivity to ANG II in human mesenteric arteries retrieved and conserved under the same conditions as transplanted organs.

Rho-kinase and GTP-ase Rho are important regulators of vascular tone and blood pressure. The aim of this study was to investigate the role of Rho-kinase in artery reactions induced by angiotensin II (ANG II) and the effects of ischemia-reperfusion injury as well as the function of intra- and extracellular calcium in these reactions. Experiments were performed on mesenteric superior arteries procured from cadaveric organ donors and conserved under the same conditions as transplanted kidneys. The vascular contraction in reaction to ANG II was measured in the presence of Rho-kinase inhibitor Y-27632, after ischemia and reperfusion, in Ca2+ and Ca2+-free solution. The maximal response to ANG II was reduced after ischemia, while an increase was observed after reperfusion. Vascular contraction induced by ANG II was decreased by Y-27632. Y-27632 reduced vascular contraction after reperfusion, both in Ca2+ and Ca2+-free solution. Reperfusion augments vascular contraction in reaction to ANG II. The Rho-kinase inhibitor Y-27632 reduces the hypersensitivity to ANG II after reperfusion mediated by both intra- and extracellular calcium. These results confirm the role of Rho-kinase in receptor-independent function of ANG II and in reperfusion-induced hypersensitivity.