PubMed Health⌕ Search

Biomedical subjects

Bolesław Papla

Publications and source records attributed to Bolesław Papla.

At least 19 recordsLinked to original sources
PubMed2006

Effect of bilateral mediastinal lymphadenectomy on short-term pulmonary function.

OBJECTIVE: To assess if the bilateral mediastinal lymphadenectomy results in lymphatic congestion in the lungs producing clinically significant impairment of respiratory function. METHODS: In the prospective, randomized, double-blind clinical study, non-small cell lung carcinoma patients underwent preoperatively mediastinoscopy or the transcervical extended mediastinal lymphadenectomy (TEMLA). In both groups, the blood gas analysis and spirometry were measured preoperatively and on the 1st, 3rd, and 5th postoperative day, and the carbon monoxide diffusing capacity of the lung (DLCO) and lung compliance were measured preoperatively and on the 3-5 postoperative day. Any respiratory complications were also recorded. RESULTS: Forty-one patients were randomized: 21 to the TEMLA group and 20 to the mediastinoscopy group. There was no significant difference of the baseline and the 1st, 3rd, and 5th day measurements of vital capacity and forced expiratory volume (FEV1) (p>0.98), pH, pO(2), pCO(2), standard bicarbonates and base excess (p>0.31), nor significant difference of baseline and 3-5 day measurements for DLCO (p=0.91) and lung compliance (p=0.38). The incidence of respiratory insufficiency was not significantly different (p=0.51). CONCLUSIONS: (1) Complete excision of mediastinal lymph nodes stations 1, 2R, 2L, 3A, 4R, 4L, 5, 6, 7, and 8 (TEMLA) is not associated with greater incidence of respiratory insufficiency comparing with standard mediastinoscopy. (2) The TEMLA procedure does not produce greater alterations in spirometry, blood gas analysis, DLCO and lung compliance comparing with standard mediastinoscopy.

Aged↗
PubMed2006

The transcervical extended mediastinal lymphadenectomy versus cervical mediastinoscopy in non-small cell lung cancer staging.

OBJECTIVE: To compare the diagnostic yield of the transcervical extended mediastinal lymphadenectomy (TEMLA) and the cervical mediastinoscopy (CM) in detecting metastatic mediastinal lymph nodes in NSCLC patients. METHODS: Prospective, randomized, single-blind clinical study. RESULTS: There were 41 NSCLC patients enrolled in the study; 21 were randomized to the TEMLA group and 20 to the cervical mediastinoscopy group. The TEMLA revealed mediastinal metastases in 7 patients, and mediastinoscopy in 3. In the TEMLA group one patient out of the 14 with negative nodes was finally found unfit for surgery, and in the remaining 13 lung resections with mediastinal dissection were performed. In the mediastinoscopy group one patient out of the 17 with negative nodes was finally found unfit for surgery and another one refused surgery, so in 15 of them lung resections with mediastinal dissection were performed. In no patient in the TEMLA group did the pathological examination of the operative specimen reveal metastatic lymph nodes, whereas in the mediastinoscopy group metastatic nodes were found in 5 patients. The number of false negative results was significantly greater in the mediastinoscopy group (5 vs 0, p=0.019), and the difference was the reason for terminating the randomization before reaching the initially planned number of 100 patients. The sensitivity of mediastinoscopy was 37.5% and its negative predictive value was 66.7%, compared to 100% and 100% in the TEMLA group. The comparison of the time of the operation, blood loss, complications, postoperative pain and the use of analgetics has shown significant differences between groups only regarding the operative time and the pain intensity, being greater in the TEMLA group. CONCLUSIONS: 1. The sensitivity and the NPV of the TEMLA in detecting mediastinal metastases in NSCLC are significantly greater than those of cervical mediastinoscopy. 2. The invasiveness of TEMLA and mediastinoscopy does not significantly differ, except for the postoperative pain.

Aged↗
PubMed2006

The relationship between MSI status and vessel density in colorectal carcinoma.

The development of new blood vessels is a prerequisite for progression of malignant neoplasms. Factors that induce neoangiogenesis include VEGF, VEGF-C, VEGF-D, PD-ECG, ANG-2, TSP-1, HIF-1 and HIF-2. From the etiopathogenetic viewpoint, colorectal carcinoma is heterogenic. It may develop via a sequence of mutations leading to chromosome instability or else result from DNA repair defects, which are manifested as microsatellite instability. The objective of the present investigations was the comparison of neoangiogenesis in microsatellite-stable colorectal carcinomas, as well as in tumors with low and high instability levels. The material included 71 surgical cases of colorectal carcinoma. Vessel density was assessed by immunohistochemical reactions to CD34 and vWf, calculating the number of vessel sections within the invasion margin, in visual fields selected at random, and within hot spots. Microsatellite instability was evaluated in frozen materials employing the PCR reaction with gel and capillary electrophoresis. In all the cases, the authors detected CD34+ and less numerous vWf+ vessels within the tumor and in its vicinity. In 45 cases, no microsatellite instability was found, in 13 cases, low level instability (MSI-L) was observed, and in another 13 - high microsatellite instability (MSI-H). Some differences in vessel density were noted between the above groups, yet they were not statistically significant. On the other hand, the authors observed more numerous CD34+ vessels in cases with metastases to the regional lymph nodes. In conclusion, it is suggested that neoangiogenesis in sporadic colorectal carcinoma is directly related to metastatic potential, but not to MSI status.

Adenocarcinoma↗
PubMed2006

High thymidylate synthase expression is typical for sporadic MSI-H colorectal carcinoma.

Colorectal carcinoma is etiopathologically heterogenic. It may develop through a sequence of mutations leading to chromosome instability or be a result of defects in DNA repair mechanisms manifested by microsatellite instability. Carcinomas of this type are supposed to be characterized by a better prognosis and a different response to chemotherapy. The main target of 5-fluorouracil (5-FU) treatment is thymidylate synthase (TS). High TS expression has been identified as promoting resistance to 5-FU. The objective of the present investigation was to determine whether microsatellite instability is associated with thymidylate synthase expression. Ninety-eight cases of colorectal carcinoma were studied. Microsatellite instability was evaluated in frozen material employing the PCR reaction with gel and capillary electrophoresis. TS expression levels were assessed in preparations stained immunohistochemically using a semiquantitative method on a scale with scores from 0 to 3. The MSI-H phenotype was detected in ten cases, MSI-L in 16, and MSS in 72. The mean TS expression score was 1.79. In the MSS group, the mean TS expression score was 1.69, in the MSI-L group the mean TS expression score was 1.73, and in the MSI-H group the mean TS expression score was 2.67. The differences between MSI-H and MSS/MSI-L were statistically significant (p<0.0002 and p<0.004, respectively). The results may explain the different response of MSI-H carcinomas to 5-FU treatment.

Adenocarcinoma↗
PubMed2006

Middle mediastinal thymoma of unusual pathologic type.

Among the many sites of ectopic thymoma development, the middle mediastinum is the rarest in the English language literature we found only two case reports. We present a case of 69-year-old woman with slow-growing, ectopic middle mediastinum thymoma of an very unusual histological type, neither classified in the Müller-Hermelink nor the World Health Organization (WHO) classification.

Aged↗
PubMed2006

Tissue microarray FISH applied to colorectal carcinomas with various microsatellite status.

Colorectal carcinoma is etiopathologically heterogenic. It may develop through a sequence of mutations leading to chromosome instability or be a result of defects in DNA repair mechanisms manifested by microsatellite instability of varying degrees. Colorectal carcinoma can thus be classified into microsatellite-stable (MSS), highly microsatellite unstable (MSI-H) and intermediate low-level microsatellite unstable (MSI-L) groups. Fluorescent hybridization in situ (FISH) is a method of detecting specific sequences of nucleic acids that is based on specific bonding of a fluorescent marker-associated probe and specific DNA fragment. The material consisted of 146 non-selected cases of colorectal carcinoma patients operated on at First Chair of General Surgery, Collegium Medicum, Jagiellonian University in Cracow, Poland. Following a standard histopathological evaluation, tissue microarrays were prepared using a Tissue MicroArray Builder, and FISH was performed employing probes specific for chromosomes 1, 8, 17 and 18. Microsatellite instability was evaluated in frozen material using the PCR reaction with gel and capillary electrophoresis. The mean number of signals obtained for chromosome 1 in the entire material was 2.06, while the corresponding mean values in the MSS group equaled 2.07, in the MSI-L group - 2.07, and in the MSI-H group - 2.01. The mean number of signals for chromosome 17 in the entire material was 2.1, in the MSS group - 2.11, in the MSI-L group - 2.13, and in the MSI-H group - 2.01. The number of signals for chromosome 18 in the entire material was 2, in the MSS group - 2, in the MSI-L group - 2, and in the MSI-H group - 2. The means number of signals for chromosome 8 in the entire material was 2.07, in the MSS group - 2.08, in the MSI-L group - 2.01, and in the MSI-H group - 2. These differences are not sufficient for distinguishing colorectal carcinoma molecular forms.

Adenocarcinoma↗
PubMed2006

Correlation of microsatellite status, proliferation, apoptotic and selected immunohistochemical markers in colorectal carcinoma studied with tissue microarray.

Colorectal carcinoma is a frequent malignant tumor, characterized by varying clinical course and response to treatment. At the molecular level, colorectal carcinomas are divided into tumors with chromosomal instability (microsatellite-stable, MSS), microsatellite instability (MSI-H) and low microsatellite instability (MSI-L). The method of tissue microarrays allows for combining materials originating from multiple patients into a single slide, what makes possible to simultaneously investigate large material for the presence of numerous, diversified markers. The study material consisted of 208 cases of colorectal carcinoma. Microsatellite instability was evaluated in frozen material employing the PCR reaction with gel and capillary electrophoresis. Following a standard histopathological assessment, tissue microarrays were prepared using a MTA-1 microarrayer (Beecher) and standard immunohistochemical reactions were performed to detect the presence of bcl-2, CDX-2, Ki67, MLH1, MSH2, MSH6, p16, p53 and survivin. Apoptotic cells were detected using the TUNEL method. The correlations between the reactions were investigated and differences in the expression of the investigated proteins noted in carcinomas with various degrees of microsatellite instability. The agglomeration analysis showed differences in patterns of expression between MSS, MSI-L and MSI-H carcinomas. The discriminant function analysis demonstrated that the MSI-H carcinomas were best differentiated by MLH1, survivin and Ki67 expression, while the MSI-L tumors differed from the remaining colorectal carcinomas by their apoptotic index, local tumor stage (pT), the presence of angioinvasion and mucin production.

Adenocarcinoma↗
PubMed2006

Choriocarcinoma within the third trimester placenta--a case report.

A small focus of choriocarcinoma has been incidentally found within an otherwise normal, third trimester placenta which was sent to the pathomorphological examination because of the stillbirth of the child at 31st week of gestation. The autopsy of the child was not performed. Macroscopically focus of choriocarcinoma has looked as a small infarct and was indistinguishable from the second lesion, which was microscopically confirmed to be a real infarct. beta-hCG level was increased at the time of delivery, but come back to normal very quickly. There were no metastases in the mother at the time of delivery and the follow-up did not show any evidence of metastatic disease either.

Adult↗
PubMed2005

Transcervical extended mediastinal lymphadenectomy--the new operative technique and early results in lung cancer staging.

OBJECTIVE: Mediastinal staging is one of the most important problems in thoracic surgery. Although the pathological examination is a generally accepted standard, none of the currently used techniques enables complete removal of all lymph node stations of the mediastinum. The aim of the study is to present a new technique of transcervical extended mediastinal lymphadenctomy (TEMLA) and to analyze its value in lung cancer staging. METHODS: In the prospective study of consecutive group of non-small cell lung cancer (NSCLC) patients, operated on between January and August 2004, we evaluated the usefulness of this original technique of bilateral mediastinal lymphadenectomy, assessing its accuracy and safety. The operations were performed through the transcervical approach, were videomediastinoscopy-assisted, with sternum elevation. Lymph node stations 1, 2R, 2L, 3a, 4R, 4L, 5, 6, 7 and 8 were removed. In patients without mediastinal metastases thoracotomy with pulmonary resection was performed and mediastinum searched for any missed lymph nodes. RESULTS: There were 83 patients operated on with the TEMLA technique. The mean number of nodes removed was 43 (range: 26-85). The sensitivity, specificity and accuracy of the presented method in detecting mediastinal node metastases were: 90, 100, and 96%, respectively, whereas the positive and negative predictive values were: 100 and 95%, respectively. CONCLUSIONS: The TEMLA technique is a safe and highly accurate method of mediastinal staging in NSCLC.

Adult↗
PubMed2005

Prognosis and survival after radical resection of primary adenosquamous lung carcinoma.

OBJECTIVE: In order to evaluate the follow-up study of surgical treatment for primary adenosquamous lung carcinoma (ASC) we specified prognostic criteria, also in comparison with primary adenocarcinoma (AC). METHODS: The study group consisted of 96 patients discharged between 1990 and 1999 after radical surgical treatment for ASC-80 (83%) men and 16 (17%) women aged 34-73, mean 56 years. Consequently, we evaluated 252 patients operated during the same time period for primary AC. RESULTS: Apart from grading, we did not find any significant differences between both ASC and AC groups of patients. Among the 96 patients operated radically for ASC median overall survival (OS) was 20 months. The cumulative postoperative survival rates at 5 and 10 years were 25.4 and 19.2%, respectively. By comparison, median OS for 252 patients with AC, discharged after surgical treatment in the same period, was 28.5 months and the cumulative postoperative survival rates at 5 and 10 years were 42.5 and 39.1%, respectively (P=0.006). At pathologic stages IA, the cumulative survival rate at 5 years was 63.3% for patients with ASC as compared with 72.1% for patients with AC (P=0.330). However, out of IB stage patients treated surgically for ASC 31.8% survived 5 years in comparison with 56.3% operated for AC (P=0.017). Study of survival rates did not differ significantly between ASC and AC patients at stage IIA (P=0.824) and stage IIB (P=0.217), respectively. Univariate analysis revealed that six factors of tumor size, T status, N status, as well visceral pleura involvement, tumor localization (central vs. peripheral) and tumor structure were significantly associated with the survival rate according to these variables. Multivariate analysis using Cox's proportional hazards model indicated that T factor, nodal involvement and one of the tumor components predominating were significant factors associated with the postoperative survival of patients with ASC. CONCLUSIONS: Our findings indicate that in patients after radical operation for ASC, predominance for one of the histopathological components (adenous or squamous) within primary tumor is attended by worst prognosis. Our study confirmed also that the prognosis of ASC of the lung was poorer than that of primary AC. Lack of generally accepted diagnostic criteria and unclear prognosis, even in the pathologic stage I suggest that there is a need for prospective studies in this respect.

Adenocarcinoma↗
PubMed2005

Primary amyloid tumors of the lungs--six cases.

Over a period of nine years, the authors followed up six cases of primary amyloid tumors of the lungs in patients at the mean age of 58.5 years. All the patients were suspected of bronchial carcinoma and they were subjected to surgical treatment. The duration of follow-up varied, but their postoperative status was satisfactory. Immunohistochemical reactions showed deposits of AL amyloid in five cases; in one of these patients, pulmonary amyloid tumors were related to marginal zone lymphoma of the lung. In one case, the accumulated amyloid was transthyretin.

Aged↗
PubMed2005

[A case of emphysema suggesting cystic lung disease in computer tomography].

Pulmonary emphysema is anatomically defined as abnormal persistent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of alveolar walls, without evident fibrosis. High-resolution computer tomography (HRCT) imaging is a valuable tool for diagnosis of this disease. The presence of minute cysts distributed evenly through all lung zones is rarely observed in pulmonary emphysema. In such cases, emphysema should be differentiated from other cystic lung diseases. We present a case of a 45-year-old women admitted to our Department with dyspnoea on exertion. Physical examination revealed no abnormalities. A chest radiograph showed diffused interstitial lesions in both lungs; HRCT revealed multiple oval-shaped cysts equally dispersed in all lung areas. The pulmonary function tests revealed increased lung volumes (total lung capacity 114.6% predicted, residual volume 200.6% of predicted), while both vital capacity and FEV1 were decreased (73.6% and 54.0% of predicted volumes, respectively). Diffused lung capacity was normal. Trans-bronchial biopsy was non contributory. Histiological examination of lung tissue obtained by videothoraco-scopy (VTS) was diagnostic for bullous emphysema. The patient had prescribed ipratropium bromide and teophyline. Differential diagnosis, apart from pulmonary emphysema, should take into consideration lymphangioleiomyomatosis, histiocytosis and sarcoidosis.

Diagnosis, Differential↗
PubMed2004

Generalized crystal-storing histiocytosis as a presentation of multiple myeloma: a case with a possible pro-aggregation defect in the immunoglobulin heavy chain.

Crystal-storing histiocytosis (CSH) with massive accumulation of particulate immunoglobulins is a rare phenomenon accompanying B-cell dyscrasias. In the reported case (M51), the disease presented as systemic CSH and later was proved to be a frank multiple myeloma. The aggregates of crystal-laden histiocytes were demonstrated in the bone marrow, lungs, kidney, and liver. Additionally, the crystalline immunoglobulin particles were identified in renal stromal cells and in hepatocytes. The patient developed lung adenocarcinoma and died 12 months after the presentation, shortly after the lobectomy. In this paper, we report the results of morphological (including electron microscopy), immunohistochemical, and biochemical analysis. The tendency for aggregation of the IgG kappa monoclonal protein was due to the abnormal physicochemical properties of its heavy chain. Massive accumulation of crystal-storing histiocytes surpassed the myeloma tumor burden and markedly contributed to the severity of the disease.

Bone Marrow↗
PubMed2004

Chronic myeloproliferative diseases on a pathologist's desk--a dilemma of distinct entities versus a clinico-pathologic continuum. A descriptive study based on a material from the Polish population.

Chronic myeloproliferative disorders (CMPD) are traditionally diagnosed using criteria based on clinical parameters. A framework for an alternative, trephine bone marrow histology-based approach, was provided by the Hanover group of hematopathologist (the "Hanover classification"). The present study describes a single institution experience with the Philadelphia-BCR/ABL negative CMPD diagnosed on the basis of the histopathology of bone marrow in the three consecutive years (2000 - 2002). Among 246 cases of CMPD (M:F=1:1.6), there were 75 cases of idiopathic myelofibrosis (IMF), 45 of polycythemia vera (PV), 93 of essential thrombocythemia (ET), and 33 cases that were unclassifiable on the basis of morphology (CMPD-U). The clinical profiles of the IMF, PV and ET group emerging from the histological examination correlated with the expected clinical features of these diseases. The ET patients were the youngest (median 51 years) compared to PV (59.5 years), IMF (63.9), and CMPD-U (54.7). In 158 cases (74.3%), the biopsy corroborated the preliminary clinical diagnosis of CMPD, and in the half of these cases it refined the clinical diagnosis of suspected unspecified CMPD placing the disease in a particular specific category (ET, IMF or PV). In the remaining cases the biopsy was done due to an abnormality of unknown origin (usually an accidentally discovered thrombocytosis) or the clinical picture suggesting a disease other than CMPD (11.7%). Some cases of CMPD presented with atypical histological features, such as slight megakaryocytic dysplasia in ET (not justifying the diagnosis of IMF), raising the issue of the subjectivity of histological diagnosis. The trephine bone marrow biopsy provides a useful tool for the diagnosis of CMPD, particularly in the early IMF that may present with a clinical picture undistinguishable from ET, but which carries poorer prognosis and requires more vigorous treatment. A special attention should be paid to the CMPD-U group. Its current nosological status (early phases of IMF/ET/PV or distinct entity or entities?) is still unclear and requires further research.

Adult↗
PubMed2004

CDX-2 expression is reduced in colorectal carcinomas with solid growth pattern and proximal location, but is largely independent of MSI status.

The homeobox genes are transcription factors that control the development of tissues and organs. In the colon one of such genes is CDX-2. In colorectal carcinomas, the CDX-2 expression is reduced. The aim of the present study was to investigate the presence of CDX-2 in colorectal carcinomas and to relate it to the histological features and microsatellite stability status. The material consisted of 20 carcinomas without microsatellite instability, 19 cases with low microsatellite instability and 19 cases with high microsatellite instability. CDX-2 expression was investigated using immunohistochemistry with CDX2-88 monoclonal antibody and assessed semiquantitatively. In 10 cases no expression of CDX-2 was observed, while in 6 the protein was present in less than 25% of tumor cells. It was noted that reduced expression of CDX-2 was more frequent in carcinomas situated proximally to the splenic flexure (p < 0.015) and in tumors with solid growth pattern (p < 0.03). On the other hand, no significant differences were encountered between groups differing in microsatellite stability. The results suggest that the major factors that determine the presence of CDX-2 in colorectal carcinomas at the protein product level may include cancer location and the solid phenotype of the tumor.

Adenocarcinoma↗