Gene expression analysis to identify mRNA markers of cardiac myxoma.

cDNA expression arrays were used to identify mRNA expression markers for cardiac myxoma. The RNA profile analysis suggests that cardiac myxoma should be considered as a stand-alone tissue rather than a pathological modification of particular normal tissue. The analysis reveals a set of genes which are highly and steadily expressed in cardiac myxomas and can serve as an mRNA expression markers of the tumour. Marker status of selected genes was confirmed by reverse transcriptase polymerase chain reaction analysis. Genes MIA (melanoma inhibitory activity) and PLA2G2A (phospholipase A2, group IIA) show the highest specificity as cardiac myxoma markers, since they have more than 10-fold higher RNA level in cardiac myxomas than in any one of 15 normal tissues tested. Among markers of myxoma at least three are participants of phospholipid metabolism: ANXA3, PLA2G2A, and phospholipid transfer protein. Tissue inhibitor of metalloproteinase 1 and secretory leucocyte protease inhibitor are inhibitors of proteases degrading extracellular matrix proteins and participating in cell proliferation regulation. MIA, SPP1, fibromodulin are modulators or participants of the interaction between extracellular matrix proteins and their cell surface receptors. SOX9 is a transcription factor required for chondrocyte differentiation. Calretenin (CALB2) is an intracellular calcium-binding protein with poorly understood function.

Improvement of weight loss and metabolic effects of vertical banded gastroplasty by an added duodenal switch procedure.

BACKGROUND: Some patients who underwent vertical banded gastroplasty (VBG) need revisional operations because of poor weight loss and remaining comorbidities. The duodenal switch (DS) procedure with partial gastrectomy is known as an effective method for treatment of severe obesity and related dyslipoproteinemias and diabetes mellitus type 2 (DM2). Other investigations have shown that DS without gastric resection similarly corrects hypercholesterolemia and DM2 in the "less than" morbidly obese patients. METHODS: Based on this knowledge, we performed a DS simultaneously with hernioplasty and panniculectomy in a 63-year-old woman with a fair EWL (36.4%), with remaining hypercholesterolemia and DM2 4 years after VBG. The pouch stoma diameter was 13 mm, and there was no pouch dilation nor staple-line disruption. The previously partitioned stomach was left in place. H2-blockers and polyvitamins were prescribed after operation. RESULTS: 1 year after DS there were no postoperative complications and undesirable effects except slight anemia. DS allowed improvement in weight loss, improved carbohydrate handling without need for insulin or other hypoglycemic agents, and corrected severe hypercholesterolemia. CONCLUSION: DS per se in the case presented had a decisive effect on DM2 and hypercholesterolemia. DS should be kept in mind as a second-step malabsorptive procedure after a failed purely restrictive operation.

Some hormonal changes before and after vertical banded gastroplasty for severe obesity.

BACKGROUND: Hormonal disturbances play a role in the development of obesity, but may be a consequence of obesity itself. In this study we assessed the influence of the surgically-induced weight loss on some important hormonal abnormalities in the morbidly obese patients. MATERIAL AND METHODS: Fasting serum prolactin, insulin, cortisol and thyroid hormones: free thyroxin (FT4), free triiodothyronine (FT3) and thyrotropin (TTH), have been studied by radioimmune methods before vertical banded gastroplasty (VBG) and after operation in the early (10-14 days) and late period when excess weight loss (EWL) 51.7-57.1% had been achieved. RESULTS: On the 10-14 day after VBG, prolactin increased significantly in women (p<0.05), but decreased after weight loss (p<0.01). Fasting insulin was lowered significantly (p<0.05) soon after VBG in the hyperinsulinemic (51.7% of the total group) and diabetic (n-9) patients. After weight loss, insulin decreased significantly (p<0.0001) vs. preoperative. Concentration of cortisol was unchanged both in the early and in the late postoperative period. On the days 10-14, significant elevation of TTH and decrease of FT3 (p<0.05) have been noted. After essential weight loss TTH dropped significantly vs. preoperative (p<0.05) with no changes in FT3 and FT4 concentration. CONCLUSIONS: VBG and consequent weight loss favorably influence the hormonal abnormalities in the morbidly obese. Further studies are needed to make clear a relationship between this and other parameters of metabolic syndrome. The hormonal abnormalities may influence the indications for surgery in less than morbidly obese patients with metabolic syndrome.