Induction of antigen-specific regulatory T cells in the liver-draining celiac lymph node following oral antigen administration.
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Regulatory T cells are induced by oral administration of an antigen, but the physiological requirements and localization of the inductive sites are largely unknown. Using an adoptive transfer system of cells transgenic for ovalbumin T-cell receptor (OVA TCR tg), we found that antigen-specific CD4+ T cells were activated in the liver-draining celiac lymph node (CLN) shortly after ovalbumin feeding, and that a significantly higher proportion of the T cells in the CLN developed into the putative regulatory phenotype [co-expressing CD25 with the glucocortico-induced tumour necrosis factor (TNF) receptor family related gene (GITR), cytotoxic T-lymphocyte antigen (CTLA)-4 and CD103] than in Peyer's patches, the mesenteric and peripheral lymph nodes and the spleen. In addition, a particularly high level of expression of CD103 on the OVA-specific T cells in the CLN may favour homing to the epithelium of the intestine. While equally suppressive, OVA tg T cells isolated from the CLN of OVA-fed DO11.10 mice were less dependent on transforming growth factor (TGF)-beta for suppression than cells isolated from the peripheral and mesenteric lymph nodes, which indicates the involvement of an additional suppressive mechanism. The expression of FoxP3 was not up-regulated in any of the lymph node compartments studied. Our phenotypic and functional findings suggest that the induction of regulatory T cells in the CLN may be relevant in the control of the immune response to dietary antigens. (+info)
Endovascular stent-grafting for thoracoabdominal aortic aneurysm following bypass grafting to superior mesenteric and celiac arteries: report of two cases.
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Two high-risk patients underwent an endovascular stent-grafting for thoracoabdominal aortic aneurysms (TAAA) following bypass-grafting to the visceral arteries. The first patient was a 73-year-old woman with severe ischemic heart disease (IHD) and chronic respiratory failure. The second patient was a 59-year-old woman with myelodysplastic syndromes (MDSs) and hepatic cell carcinoma (HCC). In general, TAAA is not considered to be indicated for endovascular stent-grafting because of the need to revascularize the visceral vessels. However, in some selected cases, such as the two cases presented herein, endovascular stent-grafting combined with bypass-grafting of the visceral arteries can be a feasible and a less-invasive alternative to conventional surgery. (+info)
Celiac axis infusion and microembolization for advanced stage III/IV pancreatic cancer--a phase II study on 265 cases.
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BACKGROUND: Despite various chemotherapeutic drugs and combinations given systemically, the impact of these agents on survival has not been convincing, and drug-related toxicity continues to be the limiting factor. PATIENTS AND METHODS: Two hundred and sixty-five patients with locally advanced or metastasizing (UICC III/IV) pancreatic cancer underwent celiac axis infusion with Mitomycin, Mitoxantrone and Cisplatin combined with degradable starch microspheres in 5 courses and 1 course of isolated hypoxic abdominal perfusion and chemofiltration. RESULTS: The study end-points were survival and quality of life. Seventy-five percent survival was 6 months, 50% (median) 9 months and 25% was 18 months. Eighty patients survived for one year and more. The longest actual survival time was ten years in a former unresectable stage IV patient. The quality of life improved in responders. No therapy-related hospitalization or increased morbidity was noted. The resectability rate after therapy in long-term survivors (>12 months) was 39%. Peritoneal carcinosis or progression of liver metastases occurred in 18%. The major cause of death in 48% was recurrence at the primary site. CONCLUSION: In good responders to arterial infusion and microembolization chemotherapy, the resectability rate increased remarkably. Relapses predominantly occurred at the primary site, and progression of distant metastases and peritoneal lesions may be reduced due to isolated abdominal perfusion. (+info)
Celiac artery compression syndrome in children, adolescents, and young adults: clinical and color duplex sonographic features in a series of 59 cases.
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OBJECTIVE: Abdominal pain is one of the most common conditions in childhood and adolescence. Celiac artery compression syndrome (CACS) is rarely suspected in this population. We present clinical and sonographic features from a series of 59 patients with this disorder. METHODS: A total of 3449 patients from 0 to 18 years were investigated with 7639 abdominal color duplex sonographic examinations. Celiac artery flow velocity was measured at the branching off from the aorta in inspiration, expiration, and in between. Diagnosis of CACS was made if a greater than 2-fold acceleration of peak systolic flow in the celiac artery compared to the abdominal aorta or a peak systolic velocity greater than 200 cm/s was measured in the mid position and if a variation of flow velocity occurred during respiration. In 22 cases, angiography (21 magnetic resonance angiography and 1 digital subtraction angiography) was used to prove sonographic diagnosis. RESULTS: Fifty-nine patients (among them 81% female) from 22 months to 19 years (clustering between 14 and 17 years) fulfilling color Doppler sonographic criteria of CACS were found, for a prevalence of 1.7%. Their symptoms included, among others, abdominal pain (71%), nausea (29%), thoracic pain (22%), heartburn (17%), weight loss (15%), vomiting (15%), systolic murmur (15%), postprandial accentuation of symptoms (15%), diarrhea (14%), respiratory discomfort (14%), and syncope (12%). CONCLUSIONS: Celiac artery compression syndrome is more prevalent than expected, and conditions not usually connected to the disease were found. Alertness to CACS is recommended, especially in patients with a combination of characteristic symptoms. Color Doppler sonography is the modality of choice for diagnosing CACS. (+info)
Analysis of cytological specimens from mediastinal lesions obtained by endoscopic ultrasound-guided fine-needle aspiration.
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BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) seems to be a powerful tool to obtain cytologic specimens from mediastinal and celiac lymph nodes, enlarged left adrenal glands, and intrapulmonary tumors with mediastinal extension. The diagnostic yield of EUS-FNA and the accuracy of cytologic specimens was evaluated. METHODS: Cytologic assessment of EUS-FNA specimens was performed and specimens were classified as positive, negative, suspicious for malignancy, or unsatisfactory for diagnosis. Cytology was compared with histologic and clinical (> or = 6 months) follow-up. RESULTS: Cytologic specimens were collected from 155 lymph nodes, 10 left adrenal glands, and 9 intrapulmonary tumor masses. For lymph nodes, the diagnostic yield was 0.65. After exclusion of unsatisfactory specimens, sensitivity, specificity, accuracy, and positive (PPV) and negative (NPV) predictive values of cytologic specimens were 0.92, 1.00, 0.93, 1.00, and 0.63, respectively. Subgroup analysis of lymph nodes with a dimension of > or = 10 mm showed similar results. With EUS imaging only, lymph node diameter and a round or irregular shape were significant predictors of malignancy at multiple logistic regression analysis, but their clinical usefulness is very limited (PPV = 0.78 and NPV = 0.45). For left adrenal gland specimens, sensitivity and specificity were 0.89 and 1.00, respectively. From intrapulmonary masses, 8 true-positive and 1 true-negative specimens were obtained. CONCLUSIONS: Cytologic specimens from mediastinal or celiac lymph nodes obtained with EUS-FNA were reliable and accurate. Specimens from left adrenal glands and intrapulmonary tumor masses showed promising results. (+info)
Total laparoscopic suprarenal aortic coral reef removal.
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Symptomatic suprarenal coral reef aortic lesions have a poor natural history and threaten visceral and lower extremity perfusion. We report our experience with total laparoscopic suprarenal aortic coral reef removal in three patients, aged 46, 48, and 52 years. Coral reef lesions were associated with aortoiliac occlusive lesions in two cases. One patient had an associated thoracic coral reef lesion. Patients underwent total laparoscopic coral reef removal combined with laparoscopic aortobifemoral bypass in two cases and open thoracic coral reef removal in one case. Postoperative courses were uneventful. All patients were alive with patent revascularization after a mean follow-up of 38 months, 29 months, and 1 month. (+info)
Splanchnic and cerebral vasodilatory effects of calcitonin gene-related peptide I in humans.
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The ability of synthetic human calcitonin gene-related peptide (CGRP I) to act as an arterial vasodilator was tested in healthy men by measuring arterial blood flow parameters in carotid, superior mesenteric, celiac, and femoral vessels. Calculated volume flow was significantly increased (140 +/- 21% of basal) in the SMA with a 2-ng/kg/min infusion of CGRP. Carotid artery volume flow increased dose dependently (96 +/- 6%, 122 +/- 15%, 135 +/- 15% of basal, respectively, with 2, 4, or 8 ng/kg/min). With steady-state infusion, carotid and superior mesenteric arterial flow parameters remained significantly elevated for 30 minutes after cessation of peptide administration. Blood pressure was unchanged. Pulse increased dose dependently. Arterial diameters were unchanged, implying activity at the arteriolar level. (+info)
Celiac artery aneurysm: a case report.
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Aneurysm of the celiac artery is an uncommon clinical problem; fewer than 180 cases have been reported in the world medical literature. Most patients are symptomatic at the time of diagnosis. However, occasionally such aneurysms are detected incidentally during diagnostic imaging for other diseases. We present the case of a 72-year-old man who had an asymptomatic celiac artery aneurysm detected by computed tomographic angiography after endoluminal exclusion of an infrarenal aortic aneurysm. The patient underwent successful resection of the aneurysm and revascularization of the aorta-common hepatic and splenic arteries with use of an autologous saphenous vein graft. (+info)