Zbigniew Kamocki

Platelets and Inflammatory Markers in Patients with Gastric Cancer

The aim of the study was to assess the contribution of platelets and inflammatory markers in gastric cancer. We studied 50 patients. Taking into consideration the advancement of gastric cancer, patients were divided into 3 groups. Group (E)—13 patients with early gastric cancer, group (A)—18 patients with regionally advanced cancer, and group (M)—19 patients with metastatic cancer. The determinations were performed twice prior to surgery and after surgery. In patients with gastric cancer, there is an increase in IL-6 and IL-23 compared with the healthy group. The highest values of IL-6 were obtained in early cancer (more than 8-fold increase), which seems to confirm the presence of acute inflammation. The lowest value of both of these cytokines was obtained in patients with metastatic cancer. In all patients, regardless of tumor stage, there was an increase in the concentration of CRP. An increase of PLT, higher proportion of the percentage of large platelets (LPLT), and increased mean platelet volume (MPV) were observed in the process of disease development. A positive correlation between MPV and LPLT and the accompanying decrease in the concentration of proinflammatory cytokines indicates the presence of an existing relationship between the platelet morphological parameters and the inflammation process in the development of gastric cancer.

Immunohistochemical assessment of apoptosis-associated proteins: p53, Bcl-xL, Bax and Bak in gastric cancer cells in correlation with clinical and pathomorphological factors.

PURPOSE The p53 protein as well as Bcl-2 family proteins such as Bax, Bak and Bcl-xL regulate apoptosis. The study objective was to analyze the expression of p53, Bak, Bcl-xL and Bax in gastric cancer and in healthy gastric mucosa. MATERIAL AND METHODS The study group consisted of 66 patients with gastric cancer, treated surgically in II Department of General and Gastroenterological Surgery, Medical University of Bialystok. The expression of the studied proteins was assessed using the immunohistochemical method. RESULTS Significant differences were found in the expressions of the studied proteins as compared to healthy gastric mucosa. The expressions of p53 and Bax were significantly higher (70% vs 13% and 50% vs 13%), whereas those of Bak and Bcl-xL significantly lower (18% vs 83% and 74% vs 97%) in cancer cells than in normal mucosa (p<0.001). Significant differences were also noted in the expressions of Bax and Bcl-xL in relation to histological type. In the intestinal type (Lauren I), the expressions of Bax and Bcl-xL were higher as compared to the diffuse type (Lauren II) (93% vs 43% and 91% vs 43%). Simultaneously, correlations were noted between changes in the expression of Bax vs Bcl-xL and Bak. High expression of Bax showed a positive correlation with reduced Bak and Bcl-xL (p<0.05). Moreover, positive expression of p53 caused poorer distant survival of patients (p<0.05). CONCLUSION Our study concluded that disturbances in the expression of p53, Bax, Bcl-xL and Bak proteins are associated with their involvement in the process of carcinogenesis in the stomach. It is suggesting that they might appeared in the early phase of carcinogenesis.

Relationships between insulin-like growth factor i and selected clinico-morphological parameters in colorectal cancer patients.

UNLABELLED Insulin Like Growth Factor (IGF I) as the one of the strongest growth factors which can affect cancers development including colorectal cancer. IGF I induces processes of the cells growth and division. It regulates cells cycle and inhibits apoptosis. There is limited data about correlation between IGF I and staging of the tumor. The aim of the study was estimation of the clinical usefulness of IGF I concentration in the serum of the patients with colorectal cancer. MATERIAL AND METHODS We have examined 125 individuals with colorectal cancer. The age range was 36 to 92 years. They have been operated in the 2nd Departament of The Gastrointestinal Surgery of the Medical University in Białystok. Serum concentration of the IGF I have been estimated using immunoassay ELISA before and after operation. Correlation between serum level of IGF I and clinicopathologic features: age, gender, localisation of the primary tumor, TNM stage of tumor, histological type and histological grade (G) of the cancer have been estimated. RESULTS Our study revealed statistically significant increased serum concentration of IGF I in patients with locally advanced colorectal cancer (pT3 and pT4) comparing to less advanced (pT2) The investigations showed higher serum concentration of IGF I in patients with poorly differentiated cancers (G3) than in moderately differentiated. Similarly higher serum concentration of IGF I were found in male, in patients older than 60 years and in mucigenous colorectal cancers. CONCLUSIONS Our results indicated that IGF I can be one of the factors of the prognosis in colorectal cancer development.

Primary splenic angiosarcoma – the same diagnosis yielding two different clinical pictures. case report

Splenic angiosarcoma has been presented as an extremely rare malignant tumour. Amongst the rarest of all neoplasms, primary splenic angiosarcoma comprises 0.14–0.25 of all annually reported cases per one million persons Splenic angiosarcoma was first described in 1879 by T. Langerhans. The clinical symptoms and diagnostic values associated with splenic angiosarcoma are extremely variable. Nonetheless, majority of the patients (75%) complain of abdominal pain, and a quarter to one-third present with rupture of the involved organ. We hereby report our experience with two splenic angiosarcoma cases, which despite being similar in their diagnosis, nonetheless present with an entirely different clinical picture. Our first case, whereby the patient presented with a liver that was also affected by the angiosarcoma of the spleen. In the second case however, although the patient did show evidence of metastasis to the abdominal cavity as well as the liver, she also suffered from primary adenocarcinoma of the colon. To our knowledge, no previous article has made mention of primary splenic angiosarcoma existing independently of another primary neoplasm. Both may be found in common practice, and ought to be highlighted for their significance as such.

Co‑existence of insulinoma and diabetes: A case report

Neuroendocrine tumors constitute a group of heterogeneous neoplasms, both those that are clinically asymptomatic and those which present with an array of symptoms. This variable clinical manifestation and unsatisfactory detection rate on diagnostic imaging make preoperative diagnosis particularly challenging. Insulinoma is a rare tumor originating from insulin-synthetizing pancreatic beta cells which clinically manifests hypoglycemia. The current study presents the case of a patient with a one month history of diabetes, and a tumor of the pancreatic head diagnosed at the Regional Hospital of Lomza (Lomza, Poland). The patient subsequently underwent surgery. The histological examination indicated insulinoma; islet cell tumor of the pancreas. The patient’s postoperative period was uneventful and during two years of follow-up, the patient has remained in good health with completely controlled diabetes mellitus. The hereby-presented case of pancreatic insulinoma confirms this finding, as a correct diagnosis could only be established on the basis of pathomorphological examination. In addition, radical surgical resection is currently the only available treatment.

Assessment of platelet activation and phagocytic activity in gastric cancer patients

AIM To assess the activation of platelets and their phagocytic activity in the course of gastric cancer. METHODS Forty-three gastric cancer patients were recruited to the study. The patients were divided into 3 groups depending on tumor stage. Group E included 6 patients with early gastric cancer; group A 18 patients with locally advanced cancer; and group M-19 with metastatic cancer. The investigations were performed twice, prior to surgery and 12-14 d afterwards. RESULTS The platelet count and the level of soluble platelet selectin (sP-selectin) were found to increase with the disease progression. The level of sP-selectin was lowest in early cancer and was observed to increase after surgery in all the study patients. Irrespective of tumor stage, a statistically significant decrease was noted in the percentage of phagocytizing platelets and in the phagocytic index in gastric cancer patients as compared to healthy subjects. Despite increased platelet count and stimulation of thrombocytopoiesis, the phagocytic functions of blood platelets were markedly impaired. Tumor development seems to impair metabolic processes. CONCLUSION A decreasing phagocytic activity can promote both inflammatory processes and cancer growth.

Parenteral nutrition and preOp preparation in prevention of post-operative insulin resistance in gastrointestinal carcinoma.

PURPOSE The aim was to compare preventive effect of total parenteral nutrition (TPN) and oral nutrition (preOp) on the perioperative insulin resistance prevention in surgical gastrointestinal cancer patients. MATERIAL/METHODS The study was conducted in a group of 75 elective gastric and large intestine cancer patients. Patients were randomly divided into 3 study groups, 25 patients each: group I (NIL) - no preparations influencing tissue sensitivity to insulin, group II (TPN) - total parenteral nutrition in its preoperative stage and group III (TPN + preOp) parenteral nutrition and preOp in the preoperative phase. RESULTS Immediately after the surgery, no statistically significant differences in insulin resistance level between groups were observed. During the first 6 postoperative hours, a statistically significant decrease of insulin resistance level in the TPN+ preOp group in comparison to others, was observed. During the first 24 postoperative hours, the NIL group was the only one to keep the insulin resistance level the same as in the preoperative phase. CONCLUSIONS Application of TPN in the preoperative phase leads to shortening of perioperative insulin resistance time. Combining TPN with oral application of carbohydrate before surgical procedure is an effective and the best method in postoperative insulin resistance syndrome prevention.

Effects of perioperative immunostimulating nutritional therapy on the phagocytic activity of blood platelets in patients with various clinical stages of gastric cancer

PURPOSE The aim of this study was to evaluate the total blood platelets count, fraction of phagocytizing thrombocytes (PhT%), and phagocytic index of thrombocytes (PhIT) in gastric cancer considering the stage of the disease, and perioperative immunonutrition support. METHODS Our study included 44 patients operated for gastric cancer divided into 2 groups depending on the clinical stage, and 40 healthy volunteers -a control group. Group I included 18 patients with stage I-III locoregional malignancies and Group II included 26 patients with stage IV peritoneal dissemination. All patients received immunonutrition during the perioperative period. The phagocytic activity of blood platelets was assessed by measuring PhT% and PhIT prior to and after nutritional therapy. RESULTS In Group I, the pre-treatment PhT% and PhIT amounted to 1.08 and 0.99, respectively, and 1.26, and 1.1 after the therapy (p<0.01). In Group II, pre-treatment PhT% and PhIT were 1.12 and 0.97, after 1.18 and 1.06, respectively (p<0.05). In the controls, PhT% and PhIT were 2.26 and 1.83, respectively, significantly higher comparing to gastric cancer patients (p<0.01). CONCLUSION Severe impairment of the thrombocyte phagocytic activity in gastric cancer patients has been found. Phagocytic activity of blood platelets was partially improved as a result of perioperative immunonutrition both in locoregional disease and in peritoneal dissemination.

Angiosarcoma of the large intestine - a case report

Hemangioendotheliomas are poorly differentiated neoplasms built from strands of endothelial cells and have a very narrow lumen filled with blood cells. Hemangioendotheliomas are commonly detected during the initial six months of life, concerning mainly soft tissues and skin. It is the most common bening liver cancer in children. In adults, hemangioendotheliomas are very rare findings, being mostly described in the liver, lungs, brain and bones. Hemangioendotheliomas of the large intestine are extremely rare in adults. Cancer developing there is of high degree of malignancy. The authors present the case of 68 year old patient in whom preoperative benign tumor with ulcers were diagnosed. Intraoperative macroscopic picture suggested malignant process. The patient underwent anterior rectal resection with regional lymphadenectomy. The postoperative histopathological evaluation with immunohistochemical studies angiosarcoma was diagnosed. A four year survival free of cancer was obtained, and the patient died due to myocardial infarct. Literature describes the short periods of survival of patients with vascular sarcoma of the colon. The most common reason for decease are metastases with massive haemorrhages. Bleeding tendency results from growing Kasabach-Merritt syndrome. It is characterized by profound thrombocytopenia and coagulopathy. The presented patient is a unique example of angiosarcoma with long period of survival.

Problem of the Insulin Resistance in Surgery

Insulin resistance is the reduced reactivity of peripheral tissues to insulin. Its measure is the ratio of the concentration of insulin acting on the cell to the volume of glucose assimilation, dependent of its concentration. In healthy subjects and normal insulinemia tissues consume 6.5-8 mg of glucose/ body weight/min (1-7). According to another definition, insulin resistance is considered as the condition of impaired biological tissue response to endoand exogenous insulin, considering the metabolism of carbohydrates, lipids, and proteins (1-9). The reasons for the occurrence of clinical manifestations of insulin resistance have not yet been clearly defined. The following factors are considered in the pathogenesis of insulin resistance: – influence of genetic factors (2, 4, 6-12), – influence of environmental factors (11-17), – influence of inflammatory cytokines and adipokines (hormones secreted by adipose tissue) (7, 8, 9, 11-15), – hypersecretion of hormones antagonistically affecting insulin (growth hormone, glucagons, glycocorticosteroids, catecholamines) (3, 6, 7, 8, 11-16, 18, 19, 20). Considering pathophysiology the following types of insulin resistance are distinguished: