Klinička važnost VEGF-A i mikrožilne gustoće u difuznom limfomu velikih B-stanica i folikularnom limfomu niskog stupnja

Angiogenesis is essential for the development, growth and progression of tumors. Although vascular endothelial growth factor (VEGF) is a well-known proangiogenic factor, its impact on lymphoma has not yet been fully clarified. The aim of this study was to evaluate VEGF-A ­expression and microvessel density (MVD) in aggressive lymphoma such as diffuse large B-cell lymphoma (DLBCL), in indolent lymphomas such as low-grade follicular lymphoma (FL), and in lymph node reactive follicular hyperplasia (FH). In 80 prospective and retrospective cases (30 DLBCL, 30 FL and 20 FH), CD31 was analyzed by immunohistochemical staining assessing density of blood vessels, as well as the total number of CD31 positive endothelial cells. The results were compared with relevant clinical data. MVD was 85% in FH, followed by 60% in DLBCL and 43% in low-grade FL. VEGF-A was significantly higher in DLBCL than in low-grade FL and FH. A statistically significant association of MVD and VEGF-A with the International Prognostic Index (IPI) was found in DLBCL. High MVD and VEGF-A expression was observed in DLBCL patients with high IPI, while there was no statistically significant association between MVD and VEGF-A with the Follicular Lymphoma International Prognostic Index in low-grade FL. Our results suggested an important relationship between angiogenesis and high-grade lymphoma.Angiogeneza je bitna za razvoj, rast i progresiju tumora. Iako je vaskularni endotelni faktor rasta (VEGF) dobro poznati proangiogeni čimbenik, njegov utjecaj na limform nije u potpunosti razjašnjen. Cilj ovoga istraživanja bio je procijeniti izraženost VEGF-A i mikrožilnu gustoću (MVD) kod agresivnog limfoma kao što je difuzni limfom velikih B-stanica (DLBCL), kod indolentnih limfoma kao što je folikularni limfom niskog stupnja (FL) i kod reaktivne folikularne hiperplazije limfnih čvorova (FH). Analiza CD31 provedena je u 80 prospektivnih i retrospektivnih slučajeva (30 DLBCL, 30 FL i 20 FH) imunohistokemijskim bojenjem za procjenu gustoće krvnih žila, kao i ukupnog broja endotelnih stanica pozitivnih na CD31. Rezultati su uspoređeni s relevantnim kliničkim podacima. MVD je bila 85% kod FH, 60% kod DLBCL i 43% kod FL niskog stupnja. VEGF-A je bio značajno viši u DLBCL u odnosu na FL niskog stupnja i FH. Statistički značajna udruženost MVD i VEGF-A s Internacionalnim prognostičkim indeksom (IPI) utvrđena je kod DLBCL. Visoka izraženost MVD i VEGF-A zabilježena je u bolesnika s DLBCL s visokim IPI, dok nije bilo statistički značajne udruženosti MVD i VEGF-A s Internacionalnim prognostičkim indeksom za folikularni limfom kod FL niskog stupnja. Rezultati ovog istraživanja ukazuju na važan odnos između angiogeneze i limfoma visokog stupnja

Laparoskopska prema otvorenoj splenektomiji: jedanaestogodišnje iskustvo u jednom centru

The 11-year experience with open (OS) and laparoscopic (LS) splenectomy at a single center is reported. A total of 201 splenectomies were performed and clinical and demographic data were retrospectively analyzed. Patients were classified according to the type of operation as LS or OS. The mean age of patients was 45.1±17.1, and 141 patients were male. Out of 43 LS, 40 were done for hematologic causes, and they had a significantly shorter hospital stay compared to OS for hematologic causes (6.87±2.2 vs. 9.84±2.9 days; p=0.000003) and significantly less requirement for blood transfusion (26.2±93.4 vs. 132.4±252.3 mL; p=0.0152). In the OS group, comparison of patients with trauma and those with hematologic causes showed that significantly more males underwent surgery for trauma causes (35 of 43 vs. 16 of 21), hospital stay was longer (18.9±27.4 vs. 9.8±2.9 days) and blood requirement higher (708.1±603.7 mL vs. 132.4±252.3 mL; p=0.0004, p=0.047 and p=0.000001, respectively). Laparoscopic splenectomy is a safe procedure for spleen removal.U radu je prikazano 11-godišnje iskustvo s otvorenom splenektomijom (OS) i laparoskopskom splenektomijom (LS) u jednom centru. Ukupno je izvedena 201 splenektomija, a klinički i demografski podaci su analizirani retrospektivno. Bolesnici su grupirani prema tipu operacije: OS ili LS. Srednja dob bolesnika bila je 45,1±17,1 godina, a ukupno je bio 141 bolesnik muškog spola. Od 43 bolesnika s LS 40 ih je podvrgnuto splenektomiji zbog hematoloških uzroka i oni su imali značajno kraću hospitalizaciju u usporedbi s OS izvedenom zbog hematoloških uzroka (6,87±2,2 prema 9,84±2,9 dana; p=0,000003), kao i značajno manju potrebu za transfuzijom krvi (26,2±93,4 mL prema 132,4±252,3 mL; p=0,0152). U skupini OS je usporedba bolesnika s traumom i onih operiranih zbog hematoloških uzroka pokazala značajno veći broj bolesnika muškog spola operiranih zbog traume (35 od 43 prema 16 od 21), dužu hospitalizaciju (18,9±27.4 prema 9,8±2,9 dana) i veću potrebu za transfuzijom krvi (708,1±603,7 mL prema 132,4±252,3 mL; p=0,0004, p=0,047 odnosno p=0,000001). Laparoskopska splenektomija je siguran zahvat za uklanjanje slezene