Cytokines and cytokine therapy in gastrointestinal diseases

AIM: To compare cytokine status in gastrointestinal diseases (GID) with reference to etiological factor, course, stage, therapy of the disease. MATERIAL AND METHODS: Enzyme immunoassay was used to examine cytokines in the peripheral blood, tissue homogenates of 560 GID patients. GID were represented by ulcer disease (UD), cholelithiasis, chronic hepatitis (CH), glutenic enteropathy (GE), Crohn's disease (CD), nonspecific ulcer colitis (NUC). RESULTS: In chronic recurrent GID (UD, cholelithiasis, GE) early exacerbation was characterized by elevated concentrations of IL-1 beta, IL-6, IL-8. Concentrations of IL-12, Inf alpha, g, TNF alpha reached maximum on the height of the disease. Intensification of regenerative processes raised concentrations of IL-4, IL-10. An overall level of serum cytokines averaged 190-780 pg/ml, reaching in some patients with active disease 1200-3000 pg/ml, in remission 30-110 pg/ml, in the control 40 pg/ml. In chronic progressive GID the levels of IL-1 beta, IL-2, IL-8, IL-6 reached 30-80 pg/ml, IL-12, Inf gamma, TNF alpha--150-370 pg/ml. A rise in cytokines concentrations in inflammatory viral, bacterial, autoimmune GID was higher than in cancer, alcoholism-related diseases, metabolic disturbances. Basic therapy in patients with chronic recurrent GID led to a significant fall in concentration of serum cytokines. Therapy with monoclonal antibodies to TNF alpha was associated with transitory pronounced favourable changes in peripheral blood cytokine status. CONCLUSION: GID provoke elevation of serum and tissue cytokines, impairment of cytokine balance in correlation with the etiological factor, variants of the course, stage of the disease, on-going therapy.     

Intraluminal sonography in the diagnosis of gastrointestinal diseases

Endosonography is an imaging method whereby a high frequency ultrasound probe is inserted into a body cavity with or without under endoscopic control. Examination of the gastrointestinal tract is performed using special echo-endoscopes or trans-endoscopic mini-probes. The gastrointestinal wall, mediastinum, pancreas, bile ducts, retroperitoneum, and other structures surrounding the gastrointestinal tract are target organs for endosonography. A detailed image of pathological processes can thus be obtained. The method can be used both for primary diagnosis of lesions and in follow-up of gastrointestinal diseases. It is accurate in local staging of cancer and in detecting small lesions. There are some limitations for optimal examination like stenoses or other factors prohibiting a precise positioning of the ultrasound transducer. The clinical importance of endo-sonographic examinations must be continuously evaluated on the basis of new technical modalities and changes in therapeutic procedures.     

Nanotechnology in diagnosis and therapy of gastrointestinal cancer

Advances in nanotechnology have opened new frontiers in the diagnosis and treatment of cancer. Nanoparticle-based technology improves the precision of tumor diagnosis when combined with imaging, as well as the accuracy of drug target delivery, with fewer side effects. Optimized nanosystems have demonstrated advantages in many fields, including enhanced specificity of detection, reduced toxicity of drugs, enhanced effect of contrast agents, and advanced diagnosis and therapy of gastrointestinal (GI) cancers. In this review, we summarize the current nanotechnologies in diagnosis and treatment of GI cancers. The development of nanotechnology will lead to personalized approaches for early diagnosis and treatment of GI cancers.     

Diagnosis and therapy of supravalvular aortic dissection (type A)--an interdisciplinary challenge

Acute dissection of the ascending aorta is a life-threatening disease. Successful management requires close teamwork of internal medical specialist, radiologist and cardiovascular surgeon. The diagnostic and therapeutic approach is reviewed on the basis of 18 of our own cases - 15 men and 3 women aged from 42 to 88 years. Peculiarities of history, pain and ECG give valuable clues to the differentiation of aortic dissection from myocardial infarction and massive pulmonary embolism. As a non-invasive rapidly available diagnostic method echocardiography may yield decisive information about the aortic root and the presence of pericardial effusion. Definite confirmation of diagnosis is accomplished by aortography and/or computed tomography. Blood pressure and aortic flow must be decreased to the lowest level tolerated by the patient to prevent pericardial tamponade or rupture into the mediastinum. The urgency of surgical repair is underlined by a median survival time of 12 hours from onset of symptoms to death with conservative treatment. 7 of our patients were operated on. In 6 cases surgery was performed by means of extracorporeal circulation and the ascending aorta was replaced by a graft. 3 patients survived the operation (2 for over 2 years and three died in the postoperative period due to cerebral and pulmonary complications). In one case with inoperable dissection an axillo-femoral bypass was performed for relief of complete ischaemia of the left lower limb. Postoperatively, maintainance of the patient's blood pressure at the low normal level ist mandatory.     

Cetuximab (Erbitux)--an emerging targeted therapy for epidermal growth factor receptor-expressing tumours

The epidermal growth factor receptor (EGFR) provides a rational target for cancer therapy as it is commonly over-expressed in a variety of solid rumours, and deregulation of its activity is associated with resistance to chemotherapy and radiotherapy and a poorer prognosis. Cetuximab is a new monoclonal chimeric antibody directed against the EGFR. It has demonstrable activity in a number of tumour types both in combination with chemotherapy and radiotherapy and on its own. The potential to combine chemotherapy and radiotherapy with cetuximab and increase efficacy without significantly increasing toxicity provides an exciting advancement in the treatment of cancers.     

内镜超声检查对消化道疾病诊治价值的认识

超声内镜（endoscopic ultrasound）开始时为机械环扫探头，主要用于消化道腔内疾病的诊断；而今内镜超声检查（endoscopic ultrasonography，EUSl）技术已进展至电子环扫、扇形扫描、前视探头和多普勒技术相结合的多系列、全面发展阶段，其临床功能也已从单纯的诊断进展至诊断与EUS引导下微创治疗相结合并以治疗为主的阶段。     

急性消化道大出血的血管造影诊断及介入治疗

目的 :评价急性消化道大出血的血管造影诊断和经导管介入治疗的价值。方法 :从 1989年到 1999年对 2 2例急性消化道大出血行选择性内脏动脉造影检查 ,其中 9例在发现出血灶的同时经导管介入治疗。结果 :2 2例中显示出血灶 19例 ,阳性率 86 % ,其中 8例显示造影剂外溢。 9例经导管栓塞或灌注血管收缩剂治疗 ,出血得到控制。结论 :选择性内脏动脉造影是诊断急性消化道大出血有价值的方法 ,经导管介入治疗安全可行     

消化道Dieulafoy病诊治策略的体会

目的 探讨Dieulafoy病治疗方法的变迁及较好的治疗策略.方法 该院近几年采用多种方法治疗Dieulafov病12例.早期治疗方法为外科手术、内镜下电凝、内镜粘膜下注射止血药;后期治疗方法为内镜下止血夹治疗和皮圈套扎治疗.结果 早期2例患者最终采用手术治疗获得成功.后期10例患者内镜下止血夹、皮圈套扎治疗或两者联合治疗均获成功,经1～4年随访并复查胃镜,未再发上消化道出血.结论 内镜下止血夹及皮圈套扎治疗疗效优、创伤小、费用低廉,已成为消化道Dieulafoy病治疗的首选方法.具体方法可根据病灶特点和时机进行选择.