Symposium, Belgian Week, Liège, 17-19 February 2011

Cajal beyond the gut : interstitial cells in the urinary system – towards general regulatory mechanisms of smooth muscle contractility ?

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Interstitial cells of Cajal (ICC), similar to GI pacemakers have been identified throughout the urinary system. Although each part of the system serves a different function, ranging from peristalsis of the ureters, storage of urine by the bladder, and a sphincteric action by the urethra, they share a common mechanism in being able to generate phasic myogenic contractions. Even the urethra, often considered to be a ‘tonic’ smooth muscle, achieves an apparently sustained contraction by averaging numerous small asynchronous ‘phasic’ contractions. This activity can occur in the absence of any neural input, implying the presence of an intrinsic pacemaker. Intracellular microelectrode recordings from urethral muscle strips reveal electrical slow waves similar to those of the GI tract. To study this further, we isolated single cells from rabbit urethra and found not only smooth muscle cells (SMC), but a second cell type comprising ~10% of the total. The latter cells were branched and non-contractile and closely resembled intestinal ICC. Electrophyiological studies revealed that, while the isolated smooth muscle cells were electrically quiescent, the ‘ICC’ fired electrical slow waves similar to those observed in the whole tissue. The basis of this difference was the presence of a large pacemaker current involving the activation of calcium-activated Cl- channels by spontaneous intracellular Ca2+ waves. These, in turn, have been shown to be modulated by neurotransmitters such as nitric oxide, noradrenaline and ATP, thus providing a possible mechanism whereby neural regulation of the urethra, as well as spontaneous tone, may be mediated via ICC. (Acta gastro enterol. belg., 2011, 74,536-542). [Product Details...]

Early versus late immune mediated inflammatory diseases

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Immune mediated inflammatory diseases (IMIDs) are life long conditions that cause substantial morbidity and disability. Though increasingly common and intensely studied, the cellular and molecular mechanisms underlying their pathogenesis are still unclear. Despite this incomplete knowledge, it is becoming increasingly evident that IMIDs evolve over time, not only from a clinical perspective but also a pathophysiological one. Evidence is accumulating that the events responsible for inflammation and damage in the target organs are not necessarily the same during the evolution of the IMID, and that the immune response evolves in parallel with the clinical manifestations. This has crucial implications for therapy because immunomodulatory interventions aimed at early pathogenic events may no longer be effective when these events have changed due to a different composition of the immune response. Therefore, it is crucial to better understand why and how the IMID associated immune abnormalities evolve over time, so that timedependent therapies may be rationally implemented for an improved clinical outcome. (Acta gastro enterol. belg., 2011, 74, 548- 552). [Product Details...]

How to prevent post-ERCP pancreatitis ?

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The incidence of post-ERCP pancreatitis (PEP) has remained constant since 30 years. During the last 10 years, large progresses have been made in the knowledge of (i) factors that predispose to PEP and (ii) measures that are effective to prevent PEP. Many of these measures have not yet been widely implemented. Complete recommendations for PEP prophylaxis are summarized in the review. For high-risk ERCPs, including ampullectomy, pancreatic sphincterotomy, precut biliary sphincterotomy, known or suspected sphincter of Oddi dysfunction, pancreatic guidewire-assisted biliary cannulation and endoscopic balloon sphincteroplasty, prophylactic pancreatic stent placement should be considered. For low-risk ERCPs, periprocedure rectal administration of NSAID is recommended. Prophylactic pancreatic stenting should be investigated in terms of education of endoscopists for insertion techniques, ease of stent insertion, reliability of spontaneous stent elimination and safety (demonstration of the absence of induced pancreatic changes). (Acta gastro enterol. belg., 2011, 74, 543-547). [Product Details...]

The Role of PET in Predicting Response to Chemotherapy in Oesophago-gastric Cancer

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Treatment options for oesophago-gastric cancers reach from limited resection to multimodality treatment. An accurate clinical assessment and prognostic information are needed for selecting the most appropriate treatment approach. Positron emission tomography (PET) in combination with computed tomography (CT) in a hybrid imaging modality may ameliorate the staging accuracy and add prognostic information. Experiences from specialised centers indicate that PET also may aid to estimate and predict response to preoperative chemotherapy and chemoradiation. This article recapitulates the value of PET in the staging and multidisciplinary care of oesophago-gastric cancer. At this stage, it remains unclear if the prognosis of patients can be improved by implementing PET in the management of this disease. Prospective multicenter studies should be performed to validate metabolic cut-off values and to proof the benefit of PET-guided treatment decisions. (Acta gastro enterol. belg., 2011, 74, 530-535). [Product Details...]

Vascular Invasion, Perineural Invasion, and Tumour Budding : Predictors of Outcome in Colorectal Cancer

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Tumour stage reflected by the AJCC/UICC TNM system is currently regarded as the most powerful prognostic parameter in patients with colorectal cancer. However, additional histopathological markers are required to improve clinical decision-making with respect to follow-up scheduling and administration of adjuvant therapy. In this review we summarize the available literature regarding the prognostic impact of venous and lymphatic invasion, perineural invasion and tumour budding in colorectal cancer. Special emphasis was placed on patients with AJCC/UICC stage II disease, the risk of lymph node metastasis in early cancer and the prediction of local recurrence in rectal cancer. For each of the markers, the different methods of evaluation, implications resulting from different definitions used in previous studies as well as future perspectives are discussed in detail. (Acta gastro enterol. belg., 2011, 74, 516-529). [Product Details...]

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