Atypical metastatic sites in rectal cancer

We report the case of a 48-year-old woman operated on for rectal carcinoma and subsequently for metastasis located in three unusual sites (i.e., laryngeal, muscular and cutaneous). Three months after the last surgery, the patient was still alive, without any detectable metastasis.     

Terminal differentiation of spontaneous rheumatoid factor–secreting B cells from rheumatoid arthritis patients depends on endogenous interleukin-1 0

Objective. The presence of serum rheumatoid factor (RF) and spontaneous RF-secreting B cells is a common feature in most patients with rheumatoid arthritis (RA). This study analyzed the cytokine(s) that controls the final maturation of B cells capable of spontaneous IgM-RF secretion in vitro. Methods. RA patients' peripheral blood mononuclear cells (PBMC), as well as adherent and nonadherent cell fractions, were cultured, and spontaneous IgM-RF and interleukin-1 0 (IL-1 0) secretion were determined by enzyme-linked immunosorbent assay. Results. The RF+ RA PBMC, but not PBMC from RF– RA patients or healthy controls, actively produced IgM-RF in a linear manner for 14 days. This activity depended on the presence of fetal calf serum and did not require cellular DNA synthesis. Spontaneous IgM-RF secretion depended on IL-1 0, as deduced from the following findings: 1) IL-1 0, but not a variety of cytokines including IL-6, restored missing IgM-RF secretion by PBMC in serum-free supplemented cultures; 2) the addition of anti–IL-1 0, but not anti–IL-6, blocking antibodies inhibited PBMC IgM-RF secretion, and this effect could be reversed by exogenous IL-1 0; and 3) RA PBMC actively produced IL-1 0 in vitro. The cells responsible for endogenous IL-1 0 production were found in the adherent cell fraction. Finally, IL-1 0 induced IgM-RF, but not total IgM, secretion by RA PBMC. Conclusion. In patients with RA, circulating B cells capable of spontaneous IgM-RF secretion require IL-1 0 production by adherent cells to reach terminal maturation.     

Treatment of Mediastinitis with Wound-Vacuum Without Muscle Flaps

Abstract   Wound vacuum may represent a new solution to the treatment of patients with mediastinitis. We herein present case reports of two patients with very serious deep wound infections of the sternum (mediastinitis) treated with wound vacuum without muscle flaps. The implications of this new modality of treatment are discussed.     

Valve-Sparing Aortic Root Remodeling with Reinforcement of the Proximal Aortic Suture-Line

Abstract   Valve-sparing aortic root remodeling is associated with the risk of bleeding from the proximal aortic-graft suture line and subsequent annular dilation leading to aortic valve failure. Herein we describe a simple technique that may be used in valve-sparing root operations to prevent bleeding and improve annular stability.     

Protection against Fas-induced liver apoptosis in transgenic mice expressing cyclooxygenase 2 in hepatocytes

Cyclooxygenase-2 (COX-2) is upregulated in many cancers, and the prostanoids synthesized increase proliferation, improve angiogenesis, and inhibit apoptosis in several tissues. To explore the function of COX-2 in liver, transgenic (Tg) mice were generated containing a fusion gene (LIVhCOX-2) consisting of human COX-2 cDNA under the control of the human ApoE promoter. Six lines were developed; all of them expressed the LIVhCOX-2 transgene selectively in hepatocytes. The Tg mice exhibited a normal phenotype, and the increased levels of PGE2 found were due to the constitutively expressed COX-2. Histological analysis of different tissues and macroscopic examination of the liver showed no differences between wild-type (Wt) and Tg animals. However, Tg animals were resistant to Fas-mediated liver injury, as demonstrated by low levels of plasmatic aminotransferases, a lesser caspase-3 activation, and Bax levels and an increase in Bcl-2, Mcl-1, and xIAP proteins, when compared with the Wt animals. Moreover, the resistance to Fas-mediated apoptosis is suppressed in the presence of COX-2-selective inhibitors, which prevented prostaglandin accumulation in the liver of Tg mice. CONCLUSION: These results demonstrate that expression of COX-2-dependent prostaglandins exerted a protection against liver apoptosis.     

Right atrial and pulmonary tumor embolism from renal rhabdomyosarcoma

A 66-year-old male presented with rhabdomyosarcoma of the right kidney with inferior vena cava tumor thrombus and with tumor emboli to right pulmonary artery and two large fragments of tumor thrombus free floating in the right atrium. The patient underwent right radical nephrectomy and thrombectomy of the right atrium and pulmonary artery. He was discharged on postoperative day 13. To our knowledge this is the first case of large tumor embolism to the right atrium and pulmonary artery from renal rhabdomyosarcoma reported in the literature.