Ruth Ladurner

Prognostic value of indoleamine 2,3-dioxygenase expression in colorectal cancer: effect on tumor-infiltrating T cells.

PURPOSE: The pathologic interactions between tumor and host immune cells within the tumor microenvironment create an immunosuppressive network that promotes tumor growth and protects the tumor from immune attack. In this study, we examined the contribution of the immunomodulatory enzyme indoleamine 2,3-dioxygenase (IDO) on this phenomenon. EXPERIMENTAL DESIGN: Expression of IDO was analyzed in colorectal cancer cell lines by reverse transcription-PCR and functional enzyme activity was assessed by high-pressure liquid chromatography. Semiquantitative immunohistochemistry was used to evaluate IDO expression in the tissue samples of 143 patients with colorectal carcinoma, and was then correlated with the number of tumor-infiltrating T cells and clinical variables. RESULTS: In vitro IDO expression and functional enzyme activity in colorectal cancer cells was found to be strictly dependent on IFN-gamma stimulation. Immunohistochemical scores revealed IDO-high expression in 56 of 143 (39.2%) tumor specimens, whereas 87 of 143 (60.8%) cases showed low IDO expression levels. IDO-high expression was associated with a significant reduction of CD3+ infiltrating T cells (46.02 +/- 7.25) as compared with tissue samples expressing low IDO (19.42 +/- 2.50; P = 0.0003). Furthermore, IDO-high immunoreactivity significantly correlated with the frequency of liver metastases (P = 0.003). Kaplan-Meier analysis showed the crossing of survival curves at 45 months. By multivariate Coxs analysis, IDO-high expression emerged as an independent prognostic variable (<45 months, P = 0.006; >45 months, P = 0.04). CONCLUSION: IDO-high expression by colorectal tumor cells enables certain cancer subsets to initially avoid immune attack and defeat the invasion of T cells via local tryptophan depletion and the production of proapoptotic tryptophan catabolites. Thus, IDO significantly contributes to disease progression and overall survival in patients with colorectal cancer.

Incarcerated recurrent inguinal hernia with covered and perforated appendicitis and periappendicular abscess: case report and review of the literature.

We report the case of a 72-year-old woman with a covered and perforated appendicitis and periappendicular abscess within the hernial sac (Amyand’s hernia) of an incarcerated recurrent inguinal hernia after primary Shouldice repair. Initially, a preoperative CT-scan showed signs of an incarcerated femoral hernia. This would be the first reported case of an incarcerated recurrent Amyand’s hernia, which is an extremely rare condition.

Nocardiosis following solid organ transplantation: a single-centre experience

Nocardiosis is a localized or disseminated bacterial infection caused by aerobic Actinomyces that commonly affects immunocompromised hosts. The aim of this study was to retrospectively review clinical course and outcome of nocardiosis in solid organ recipients at our centre. Five cases of nocardiosis were identified in a series of more than 4000 consecutive solid organ transplants performed at Innsbruck university hospital during a 25‐year period. Of the five patients with nocardiosis, two had undergone multivisceral, one liver, one kidney and one lung transplantation. Three patients with Nocardia asteroides infection were treated successfully and recovered from their infectious disease, however, one lost his renal graft following withdrawal of immunosuppression. The lung recipient recovered from nocardiosis but died later on from Pseudomonas pneumonia. One multivisceral recipient died from Nocardia farcinica‐disseminated infection. Nocardiosis is a rare, difficult‐to‐diagnose‐and‐treat complication following solid organ transplantation. Intestinal recipients might be at increased risk to develop this infection.

Adenocarcinoma arising in a cystic duplication of the small bowel: case report and review of literature

Enteric duplications are rare, but can occur anywhere along the digestive tract. Most of the patients become symptomatic in early childhood and only a few cases of adult patients have been reported in literature. Here we report a unique case of an adenocarcinoma arising in a coincidentally found cystic duplication of the small bowel.

Expression of toll-like receptors 1-5 but not TLR 6-10 is elevated in livers of patients with non-alcoholic fatty liver disease

Animal models of non‐alcoholic fatty liver disease (NAFLD) suggest that an increased translocation of bacterial endotoxins, leading to an activation of toll‐like receptor‐dependent signalling cascades (TLRs) and increased formation of reactive oxygen species, may add to development of insulin resistance and induction of plasminogen activator inhibitor‐1 (PAI‐1) in the liver. If similar mechanisms are also involved in the development of NAFLD in humans remains to be determined.

Complete hepatic ischemia due to torsion of a large accessory liver lobe: first case to require transplantation

Anatomical abnormalities of the liver are extremely rare. Although the majority of cases with an accessory liver are not detected, it can give rise to various clinical symptoms like recurrent abdominal pain and impaired liver function. Here we present the first case of orthotopic liver transplantation in a patient with hepatic ischemia caused by complete vascular occlusion due to a twisted accessory liver lobe. Although rare, an accessory liver lobe may cause serious and life‐threatening problems and should therefore be kept in mind in patients presenting with acute abdominal pain.

The impact of a micro-lightguide spectrophotometer on the intraoperative assessment of hepatic microcirculation : A pilot study

INTRODUCTION The intraoperative measurement of the peripheral microperfusion after liver transplantation is connected with quite an effort and a continuous evaluation in the postoperative follow up is not possible till now. PATIENTS AND METHODS Before mobilization of the liver during surgical intervention the following parameters were measured on the surface of the right (segment 7/8) and the left (segment 2/3) liver lobe with a probe, combining laser-Doppler-flowmetry and tissue-spectrometry: the oxygen saturation (SO2), the relative capillary hemoglobin concentration (rHB), the blood flow (flow) and the blood flow velocity (velo). In addition the peripheral oxygen saturation (SPO2), the central venous pressure (ZVP), the positive endexspiratory pressure (PEEP) and the hemoglobin (HB) were documented. RESULTS 9 patients (median age 75 years) were included in the study. SPO2, ZVP, PEEP and HB were regular. The parameters SO2, rHB, flow and velo showed no significant changes between the right and the left liver lobe. CONCLUSIONS The O2C-method allows a reproducible intraoperative evaluation of the hepatic microcirculation.

Contributors to individual quality of life after liver transplantation.

Eur J Clin Invest 2012

Donor heparinization is not a contraindication to liver transplantation even in recipients with acute heparin-induced thrombocytopenia type II: a case report and review of the literature

Heparin‐induced thrombocytopenia (HIT) type II is caused by an immune‐mediated side effect of heparin anticoagulation resulting in a clotting disorder. In the setting of urgent liver transplantation, the question arises whether a graft from a heparinized donor can be safely transplantated in a recipient with even acute heparin‐induced thrombocytopenia type II. We report on a patient with end‐stage liver disease and acute HIT II waiting for liver transplantation. Despite the risk of life‐threatening complications, an organ procured from a heparinized donor was accepted. Assuming heparin residuals within the graft, the donor organ was flushed backtable with increased amounts of Wisconsin solution. The subsequent transplantation and the postoperative course were uneventful; neither thromboses nor graft dysfunction occurred. Even in acute episode of HIT II with circulating antibodies, a patient may receive an organ from a heparin‐treated donor, if adequate precautions during organ preparation are observed.

Cellular Liver Regeneration after Extended Hepatic Resection in Pigs

Background. The liver has an enormous capacity to regenerate itself. The aim of this study was to evaluate whether the regeneration is due to hypertrophy or hyperplasia of the remnant liver after extended resection and whether a portosystemic shunt is beneficial. Material and methods. An extended left hemihepatectomy was performed in 25 pigs, and in 14 after performing a portosystemic shunt. During follow up, liver regeneration was estimated by macroscopic markers such as liver volume and size of the portal fields [mm2] as well as the amount of hepatocytes per portal field and the amount of hepatocytes per mm2. Results. Regardless of the operation procedure, the volume of the remnant liver increased about 2.5 fold at the end of the first week after resection. The size of the portal fields increased significantly as well as the number of hepatocytes in the portal fields. Interestingly, the number of hepatocytes per mm2 remained the same. Conclusion. After extended resection, liver regeneration was achieved by an extensive and significant hyperplasia of hepatocytes within the preexisting portal fields and not by de novo synthesis of new portal fields. However, there was no difference in liver regeneration regarding the operation procedure performed with or without portosystemic shunt.