Management of a Case of Colovesical Fistula with Fecaluria as First Sign

Introduction. Fecaluria and pneumaturia are the patognomonic signs of an abnormal communication between the bladder and the intestinal tract. Therefore, when a history of digestive signs, symptoms or digestive diseases is missing, this borderline pathology leads the patients in the care of urologists. From diagnosis to treatment the management of these cases can be difficult and challenging. Materials and Methods. A 48 year old patient, without any significant medical history, presented to the emergency room for fecaluria, pneumaturia and an episode of haematuria. He had no prior digestive symptoms. The contrast enhanced abdominal and pelvic CT scan revealed a pelvic mass involving the sigmoid colon and the dome and the posterior wall of the bladder. The cystoscopy objectifies a tumor mass involving the right postero-lateral bladder wall, with extravasation of faeces. A biopsy was taken and the frozen section found mainly uncertain inflammatory type tissue. A colonoscopy couldn’t be done because of an impassable obstacle at 15 cm from the anus. Together with general surgeons we decided for en bloc resection of the tumor with partial cystectomy, right ureterocystoneostomy and rectosigmoid resection with mechanic end to end anastomosis. Results. The postoperative period was uneventful. The histopathological examination revealed an abscessed sigmoid diverticulum with vesico-sigmoid fistula and perilesional inflammatory tissue. Two years after the surgery the patient is asymptomatic with a normal function of the right kidney and restored bladder capacity. Conclusions. Being a borderline pathology, patients with fecaluria and pneumaturia and lack of digestive symptoms are referred and managed by the urologists. Despite extensive investigations, even when preoperative biopsies reveal inflammatory tissue the patients should be treated as oncologic cases. A close cooperation with general surgeons for en bloc multiorgan resection within oncologic safety margins is mandatory

Liver procurement as part of multiple organ procurement

Departamentul de Chirurgie Generală şi Transplant Hepatic “Dan Setlacec”, Institutul Clinic Fundeni, Bucureşti, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Scop: Prelevarea hepatică, etapă premergătoare transplantului hepatic, parte din prelevarea multiorgan, contribuie prin acuratețea și corectitudinea intervenției la obținerea unei grefe hepatice de bună calitate cu rezultate bune ale transplantului atît imediate cât și pe termen lung. Lucrarea de față își propune să evidențieze importantul rol al identificării variantelor anatomice și adaptarea metodelor de prelevare în funcție de acestea.Material şi metode: Pe parcursul perioadei 1 ianuarie 2000-16 iunie 2015 s-au efectuat în Centrul nostru 666 prelevări multiorgan. O importanță deosebită a fost acordată recunoașterii variantelor anatomice arteriale, acestea adaugând un grad de dificultate procedurii, dar fiind totodată esențiale pentru asigurarea succesului intervenției. Rezultate: Caracteristicile heterogene ale donatorilor au obligat la aplicarea unei game variate de tehnici de prelevare, adaptate fiecărei situații, așa cum au fost descrise în lucrarea de față, un pas cheie pentru obținerea unei grefe viabile pentru transplant. Concluzii: Multiplele tehnici de prelevare hepatică pot fi aplicate cu succes când sunt adaptate fiecarui donator, scurtând timpul de prelevare și furnizând o grefă de cea mai bună calitate.Purpose: Liver procurement, the preliminary stage of liver transplantation, is a part of multi-organ procurement, and it contributes, with its accuracy and correctness to the high quality liver graft, with the best results in the transplantation process (both immediate and long term). This paper is framed to enlighten the important role of identification of anatomical variants and the selection of the procurement technique that suits most. Material and methods: During 1st Jan 2000-16th Jun 2015 a number of 666 multi-organ procurements were performed in our center. A special attention was paid in recognizing of anatomical variants of blood vessels (especially arterial blood vessels), which added a high degree of difficulty to the procedures, but was considered to be vital in order to ensure the success of the intervention. Results: Heterogeneous characteristics of donors imposed the implementation of a variety of sampling techniques, adapted on each situation as was described in the paper, an essential step to obtain a viable liver / organ graft suitable for the transplant. Conclusions: The multiple methods of liver procurement can be successfully applied when it is adapted to each of the donors, thus shortening the actual time of the liver harvesting, delivering the best quality of the new liver graft

Expression and structural features of endoglin (CD105), a transforming growth factor beta1 and beta3 binding protein, in human melanoma.

Human endoglin (CD105) is a member of the transforming growth factor beta (TGF-beta) receptor family that binds TGF-beta1 and -beta3, but not TGF-beta2, on human endothelial cells. Immunohistochemical analyses demonstrated that CD105 is expressed on normal and neoplastic cells of the melanocytic lineage. The anti-CD105 MAb, MAEND3, stained 50, 25 and 34% of intradermal naevi, primary and metastatic melanomas investigated, respectively, and nine out of 12 melanoma cell lines. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis revealed that CD105 expressed by melanoma cells consists of a homodimeric protein with an apparent molecular weight of 180 and 95 kDa under non-reducing and reducing conditions. Cross-linking of 125I-labelled TGF-beta1 to melanoma cells, Mel 97, by disuccinimidyl suberate (DSS) demonstrated that CD105 expressed on pigmented cells binds TGF-beta1; the pattern of binding of TGF-beta1 to melanoma cells was found to be similar to that of human umbilical vein endothelial cells. The addition of exogenous, bioactive TGF-beta1 significantly (P<0.05) inhibited the growth of CD105-positive melanoma cells, Mel 97, but did not affect that of CD105-negative melanoma cells, F0-1. These data, altogether, demonstrate that CD105 is expressed on pigmented cells and might play a functionally relevant role in the biology of human melanoma cells by regulating their sensitivity to TGF-betas

Liver transplantation in Romania

Institultul Clinic Fundeni-Clinica Chirurgie Generală și Transplant Hepatic “Dan Setlacec”, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Analiza retrospectivă a 300 de transplanturi hepatice efectuate în Centrul de Chirurgie Generală și Transplant Hepatic “Dan Setlacec “.Retrospective analysis of 300 liver transplantation performed in General Surgery Center and Liver Transplantation “Dan Setlacec”

Mixed Quotation

The central challenge posed by mixed quotation is that it exhibits both regular semantic use and metalinguistic reference, simultaneously. Semanticists disagree considerably on how to capture the interplay between these two meaning aspects. In this case study I present the various semantic approaches to mixed quotation and compare their predictions with respect to empirical phenomena like indexical shifting, projection, and non‐constituent mixed quotation

Human recombinant anti-thyroperoxidase autoantibodies: in vitro cytotoxic activity on papillary thyroid cancer expressing TPO

International audienceBACKGROUND: Thyroid cancers are difficult to treat due to their limited responsiveness to chemo- and radiotherapy. There is thus a great interest in and a need for alternative therapeutic approaches. RESULTS: We studied the cytotoxic activity of anti-thyroperoxidase autoantibodies (anti-TPO aAbs, expressed in baculovirus/insect cell (B4) and CHO cells (B4') or purified from patients' sera) against a papillary thyroid cancer (NPA) cell line. Anti-TPO aAbs from patients' sera led to a partial destruction of NPA cell line by complement-dependent cytotoxicity (CDC) and antibody-dependent cell-mediated cytotoxicity (ADCC) and exhibited an anti-proliferative activity. Comparison of the cytotoxic activity of anti-TPO aAbs shows that B4' induced an anti-proliferative effect and a better ADCC than B4, but a lower one than anti-TPO aAbs from patients' sera. Antibody-dependent cell-mediated cytotoxicity was increased when human peripheral blood mononuclear cells were used as effector cells, suggesting that FcgammaRs, CD64, CD32 and CD16 are involved. Indeed, anti-TPO aAbs from patients' sera, but not B4 and B4', exhibited CDC activity. CONCLUSIONS: These data indicate that anti-TPO aAbs display moderate ADCC and anti-proliferative activities on NPA cells; IgG glycosylation appears to be important for cytotoxic activity and ADCC efficiency depends on FcgammaR-bearing cells. Finally, recombinant human anti-TPO aAbs cannot yet be considered as an optimal tool for the development of a novel therapeutic approach for thyroid cancer

Cumulative readings of every do not provide evidence for events and thematic roles

An argument by Kratzer (2000) based on Schein (1986, 1993) does not conclusively show that events and thematic roles are necessary ingredients of the logical representation of natural language sentences. The argument claims that cumulative readings of every can be represented only with these ingredients. But scope-splitting accounts make it possible to represent cumulative readings of every in an eventless framework. Such accounts are motivated by obligatory reconstruction effects of every and by crosslinguistic considerations. Kratzer proposes that agent but not theme occurs in the logical representation of sentences because this allows her to model subject-object asymmetries in the distribution of cumulative every. But the reason for these asymmetries seems to be that every must be c-commanded by another quantifier in order to cumulate with it, no matter what its thematic role is. So the distribution of cumulative every does not provide support for Kratzer’s proposal

Structure, distribution, and functional role of protectin (CD59) in complement-susceptibility and in immunotherapy of human malignancies - (Review)

Protectin (CD59) is a glycosyl-phosphatidylinositol-anchored cell membrane glycoprotein, ubiquitously expressed, though to a different extent, on benign and malignant cells. CD59 inhibits complement (C)-mediated lysis of target cells by preventing the formation of the membrane attack complex, in the terminal step of C-activation. Recent experimental evidence demonstrates that CD59 is the main restriction factor of C-mediated lysis of malignant cells of different histotype. Additionally, a soluble form of CD59, that retains its anchoring ability and functional properties, has been most recently identified in body fluids and in culture supernatants of different malignant cells. In view of its functional role, CD59 may protect neoplastic cells from C-mediated lysis, contributing to their escape from innate C-control and to tumor progression; additionally, the expression of CD59 by neoplastic cells may contribute to impair the therapeutic efficacy of C-activating monoclonal antibodies (mAb) directed to tumor-associated antigens. In the light of the functional role of CD59, this review focuses on the structural features, tissue distribution and regulation of the expression of CD59 in malignant tissues, and on the foreseeable application(s) of CD59 to improve the therapeutic efficacy of clinical approaches of humoral immunotherapy with C-activating mAb in human malignancies

Management of a case of colovesical fistula with fecaluria as first sign

Introduction. Fecaluria and pneumaturia are the patognomonic signs of an abnormal communication between the bladder and the intestinal tract. Therefore, when a history of digestive signs, symptoms or digestive diseases is missing, this borderline pathology leads the patients in the care of urologists. From diagnosis to treatment the management of these cases can be difficult and challenging. Materials and Methods. A 48 year old patient, without any significant medical history, presented to the emergency room for fecaluria, pneumaturia and an episode of haematuria. He had no prior digestive symptoms. The contrast enhanced abdominal and pelvic CT scan revealed a pelvic mass involving the sigmoid colon and the dome and the posterior wall of the bladder. The cystoscopy objectifies a tumor mass involving the right postero-lateral bladder wall, with extravasation of faeces. A biopsy was taken and the frozen section found mainly uncertain inflammatory type tissue. A colonoscopy couldn’t be done because of an impassable obstacle at 15 cm from the anus. Together with general surgeons we decided for en bloc resection of the tumor with partial cystectomy, right ureterocystoneostomy and rectosigmoid resection with mechanic end to end anastomosis. Results. The postoperative period was uneventful. The histopathological examination revealed an abscessed sigmoid diverticulum with vesico-sigmoid fistula and perilesional inflammatory tissue. Two years after the surgery the patient is asymptomatic with a normal function of the right kidney and restored bladder capacity. Conclusions. Being a borderline pathology, patients with fecaluria and pneumaturia and lack of digestive symptoms are referred and managed by the urologists. Despite extensive investigations, even when preoperative biopsies reveal inflammatory tissue the patients should be treated as oncologic cases. A close cooperation with general surgeons for en bloc multiorgan resection within oncologic safety margins is mandatory