Evaluations of the combined use of blood- and tissue-based protein biomarkers for pancreatic cancer.

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy with a low 5-year survival rate. Biomarkers may be of value for the early diagnosis of pancreatic cancer. This study assessed blood- and tumour tissue-based biomarkers associated with pancreatic cancer. METHODS: We studied 61 patients who underwent pancreatic resection. Of these 61 patients, 46 patients had PDAC, and 15 patients had inflammatory tumours. Blood and tumour tissue levels of VEGF, hypoxia-inducible factor 1α (HIF-1α) and glucose transporter 1 (GLUT1) were measured. RESULTS: Blood concentrations of VEGF (p < 0.000001) and HIF-1α (p = 0.000002) were significantly higher in the PDAC group than in the inflammatory tumour group. Tumour tissue concentrations of VEGF (p < 0.000001), HIF-1α (p = 0.000005) and GLUT1 (0.000002) were also significantly higher in the PDAC group. Univariate analyses revealed that age, BMI, and blood levels of CA19-9, VEGF, and HIF-1α were potential predictors of PDAC. Potential predictors of PDAC in tumour tissue were VEGF, HIF-1α and GLUT1. Multivariate analyses found that VEGF was the most powerful independent predictor of PDAC in blood (OR = 1.016; 95% CI: 1.007-1.025; 0.001) and tumour tissue (OR = 1.02; 95% CI: 1.008-1.032, p = 0.001). The cut-off point for blood VEGF was 134.56 pg/ml, with a sensitivity of 97.8%, specificity of 86.7%, PPV of 95.7%, and NPV of 92.9%. The cut-off point for tissue tumour VEGF in PDAC was 208.59 pg/mg, with a sensitivity, specificity, PPV and NPV of 97.7%, 92.9%, 97.7%, and 92.9%, respectively. CONCLUSIONS: There are significant differences in blood-based biomarkers for differentiating between PDAC and inflammatory tumours of the pancreas. VEGF was an independent predictor of PDAC independent of its addition to the routinely used tumour marker CA19-9 antigen.

3D printing in the endovascular treatment of visceral artery aneurysms.

Visceral artery aneurysms (VAAs) are vascular pathologies that are difficult to treat. The variable geometry of the vessels and the location of aneurysms render difficult their evaluation in radiological imaging studies. Less invasive endovascular procedures are increasingly used in common practice. Our aim was to test the feasibility of using 3D printing technology in the preparation of preoperative spatial models of visceral artery aneurysms and their impact on interventional treatment. In our observational study, we examined a group of patients with true aneurysms of the visceral arteries who were followed and who underwent endovascular procedures with the use of 3D prints for better imaging of vascular lesions. We analyzed the fused filament fabrication method of 3D printing and printable materials in the preparation of spatial vascular models. We confirmed that more accurate visualization and analysis of vascular anatomy could assist operators in attempting minimally invasive treatment with good results. Extending imaging studies using 3D printing models that allow for the assessment of the position, morphology and geometry of the aneurysm sac, particularly of vessel branches, could encourage surgeons to perform endovascular procedures.

Blood-based protein biomarkers and red blood cell aggregation in pancreatic cancer.

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is highly malignant with a low 5-year survival rate. Blood biomarkers may be of value for the noninvasive diagnosis of pancreatic cancer. OBJECTIVE: This study assessed blood-based biomarkers and disturbances in red blood cell aggregation associated with pancreatic cancer. METHODS: We studied 61 patients who underwent pancreatic resection. Of these 61 patients, 46 patients had PDAC, and 15 patients had inflammatory tumours. Serum VEGF, hypoxia-inducible factor (HIF-1α), elastin-derived peptides (EDPs), total sialic acid (TSA) and resistin levels were measured. Red blood cell aggregation was assessed by a laser-assisted optical rotational cell analyser. RESULTS: VEGF (p < 0.000001), HIF-1α (p = 0.000002), resistin (p = 0.000349), EDP (p = 0.000089) and TSA (p = 0.000013) levels were significantly higher in the PDAC group than in the inflammatory tumour group. The aggregation index (AI), syllectogram amplitude (AMP) and threshold shear rate (γthr) were significantly higher in the PDAC group, whereas the aggregation half-time (t1/2) was lower than in the inflammatory tumour group. Multivariate analyses revealed that VEGF, TSA and EDP levels were variables that predicted PDAC. VEGF levels were the most powerful predictor of PDAC independent of CA 19-9 levels. The cut-off points for VEGF, TSA and EDP levels were 134.56 pg/ml, 109.11 mg/dl and 36.4 ng/ml, respectively, with sensitivities of 97.8%, 87% and 69.6%, respectively, and specificities of 86.7%, 86.7% and 93.3%, respectively. CONCLUSION: This study indicated that there are significant differences in blood-based biomarkers for differentiating between PDAC and inflammatory tumours of the pancreas. We also confirmed that PDAC is associated with the excessive aggregation of RBCs.

Post-COVID­19 complications in hospitalized and nonhospitalized patients: the Silesian database of COVID­19 complications (SILCOV­19).

INTRODUCTION: Due to the extent of the pandemic, high prevalence and severity of complications in the early post­recovery period are expected. OBJECTIVES: This study aimed to compare the scope of early post-COVID­19 complications in patients who had the disease and were or were not hospitalized. PATIENTS AND METHODS: This was a prospective, observational, registry­based cohort study conducted at a tertiary cardiovascular hospital in Silesia, Poland. Interdisciplinary diagnostics, including cardiovascular, pneumatological, respiratory, neurological, and psychiatric tests, was performed during the study visit. All patients completed the study. Two­hundred unselected, adult, white men and women with the symptoms of acute COVID­19 were included, of which 86 patients had the disease but did not require hospitalization. RESULTS: The median (interquartile range) time from symptom onset to the study visit was 107 (87-117) and 105 (79-127) days in nonhospitalized and hospitalized patients, respectively. Lung lesions on high­resolution computed tomography were found in 10 (8.8%) and 33 (39.3%) of nonhospitalized and hospitalized patients, respectively (P <0.01); no lesions were visualized on chest X­ray images. Elevated platelet distribution width was found in more than 70% of the patients in both groups. More than half of the patients had insomnia, regardless of the hospitalization status. CONCLUSIONS: The abnormal platelet parameters, functional and radiological findings in the lungs, and insomnia were the most frequent short­term COVID­19 complications in hospitalized and nonhospitalized patients. Considering the number of patients who have had COVID­19 worldwide, a high burden of the post-COVID­19 complications might be expected.

3D printing in the preoperative planning and endovascular treatment of splenic artery aneurysm. Own clinical experience and literature review.

Splenic artery aneurysms (SAAs) are the most common visceral aneurysms. Endovascular treatment of SAAs is increasingly used. Appropriate preoperative imaging of aneurysms is crucial to treatment planning. The case of a patient with accidentally detected SAA on angio-CT examination was the basis for implementation of 3D printing to prepare an artery model. The 3D model made it easier to qualify for endovascular treatment of the SAA and helped to visualize its morphology. An excellent treatment effect was achieved. 3D printing provides an opportunity for better visualization of SAA anatomy, which has a direct impact on the choice of minimally invasive treatment method.

Effect of Weight Loss Surgery on Biomarkers of Angiogenesis in Obese Patients.

BACKGROUND: The present study aims to clarify the effects of weight loss on biomarkers associated with angiogenesis in patients who underwent laparoscopic sleeve gastrectomy (SG) or adjustable gastric banding (LAGB) in the 12-month follow-up study. MATERIALS AND METHODS: We studied 24 obese patients who underwent laparoscopic weight loss surgery, 13 of whom underwent SG and 11 of whom underwent LAGB. We evaluated the circulating level of angiogenesis biomarkers preoperatively and 12 months after surgery. RESULTS: Before surgery, the following angiogenic circulating factors were significantly higher than those of healthy subjects: angiopoietin 2 (ANG-2) (p < .05), granulocyte colony-stimulating factor (G-CSF) (p < .05), hepatocyte growth factor (HGF) (p < .01), platelet endothelial cell adhesion molecule (PECAM-1) (p < .01), and vascular endothelial growth factor (VEGF) (p < .05). The following angiogenesis biomarkers decreased significantly after weight loss compared with their baseline values: ANG-2 (p < .05), follistatin (p < .05), HGF (p < .01), PECAM-1 (p < .01), and VEGF (p < .05). There were no significant differences in the circulating levels of angiogenesis biomarkers between individuals who underwent SG and those who underwent LAGB; however, HGF, PECAM-1, and VEGF tended to be lower after SG. %BMI correlated negatively with HGF, PECAM-1, and VEGF. A similar significant negative correlation was found for %WL and %EWL. WHR correlated with PDGF-B and VEGF. CONCLUSIONS: We concluded that weight loss surgery induces the changes of circulating levels of angiogenesis biomarkers in obese patients. The changes in angiogenesis status in obese patients who lost weight after bariatric surgery depended on the amount of weight loss.

The effects of venous hemodynamics on angiogenesis in morbid obese.

BACKGROUND: It is known that obesity is associated with alterations in blood rheology and venous hemodynamics. Another recent study has confirmed that adipose tissue is actively involved in angiogenesis through secretion of biologically active substances. OBJECTIVE: The aim of this study was to investigate the impact on the venous haemodynamics of the femoral vein on angiogenesis status in morbidly obese patients. METHODS: We studied venous haemodynamics and angiogenesis in a prospective study of obese and non-obese individuals. The venous wall shear stress (WSS) was calculated from the blood viscosity and the shear rate was calculated assuming Newton's law. Angiogenesis was detected using Bio-Plex Pro Human Angiogenesis Multiplex Assays (Bio-Plex 200 Systems). RESULTS: The shear rate (P < 0.000005) and the wall shear stress (P < 0.01) were significantly lower in the obese patients compared with the control subjects. All angiogenesis biomarkers were significantly higher in obese patients compared to the control group. Multivariate analyses identified waist circumference as an independent predictor for PECAM-1 (ß = - 0.69, P < 0.0001) and for VEGF (ß = - 0.60, P < 0.001); analyses identified WSS as an independent predictor for follistatin (ß = - 0.59, P < 0.001), for PECAM-1 (ß = - 036, P < 0.05) and for VEGF (ß = - 0.42, P < 0.05). For angiopoietin 2 (ß = - 0.35, P = 0.064) and HGF (ß = - 0.31, P = 0.074), WSS tended to be a significant predictor. CONCLUSIONS: The results indicated that obesity-associated decreases in shear stress of the venous system lead to upregulation of angiogenesis, expressed by increased levels of endogenous positive regulators of angiogenesis.

The relationship between the rheological behavior of RBCs and angiogenesis in the morbidly obese.

OBJECTIVE: The aim of this study was to investigate the relationship between red blood cell (RBC) aggregation and deformability and angiogenesis parameters in obese patients. METHODS: We studied 35 obese subjects and 20 non-obese people as a control group. Angiogenesis was detected using Bio-Plex Pro Human Angiogenesis Multiplex Assays. The RBC aggregation and deformability of the red blood cell aggregation were performed by the Laser-assisted Optical Rotational Cell Analyser - LORCA. RESULTS: The aggregation index and the syllectogram's amplitude were significantly higher in the obese patients, whereas the aggregation half-time (t1/2) was lower compared with the control group. The deformability of RBC expressed as EI was significantly lower in the obese group than it was in the control group. All angiogenesis parameters were higher in obese individuals than they were in the control group. Significant differences were observed in angiopoietin 2 (p = 0.048), folistin (p = 0.0017), G-CSF (p = 0.042), HGF (p = 0.016), and PECAM-1 (p = 0.014). The VEGF tended to be higher in the obese patients than in the control group (p = 0.09); nevertheless, the concentration of PDGF-BB was similar in both groups. EI at shear stresses of 18.49 Pa and 30.2 Pa was strongly correlated with all angiogenesis parameters. No correlations were found between the studied RBC aggregation indices and angiogenesis parameters. Multivariate analyses indicated that only HGF was an independent predictor of RBC deformability at 18.49 Pa (ß-0.83, P < 0.000005) and at 30.2 Pa (ß-0.83, P < 0.00005). CONCLUSIONS: The study found that there are relationships between enhanced RBC rigidity and angiogenesis status in obese subjects. Because this correlation between angiogenesis and RBC deformability is presented for the first time, the physiological importance of the relationship requires further research.

Serum omentin-1 and chemerin concentrations in pancreatic cancer and chronic pancreatitis.

Pancreatic ductal adenocarcinoma (PDAC) is characterized by very poor prognosis. It is caused by asymptomatic course of the disease at early stage. Symptomatic PDAC means usually advanced stage of the disease, making radical treatment impossible. Finding of biological PDAC marker could improve PDAC treatment through early diagnosis. In our study, we investigated two adipokines: omentin and chemerin concentration in PDAC, chronic pancreatitis (CP) and healthy individuals. We examined 27 PDAC patients, 10 CP patients and 36 controls. To determine concentration of adipokines we used ELISA immunoenzymatic assay. Level of both adipokines was increased when comparing control group to PDAC patients. Additionally, chemerin concentration in CP group was elevated comparing to control. To evaluate both adipokines as potential PDAC biomarkers we performed ROC analysis. Chemerin (AUC = 0.913) displayed better discriminant ability than omentin-1 (AUC = 0.73). Some authors believe that chemerin may promote tumour growth by stimulating angiogenesis and is supposed to be a factor recruiting mesenchymal stroma cells (MSC) in tumour regions. Omentin-1 can inhibit tumourigenesis by TP53 stimulation. On the other hand, according to some studies, omentin-1 may promote cancer proliferation via Akt signalling pathway. Results from our study showed significantly elevated level of chemerin and omentin-1 in PDAC patients. Therefore, we believe that both investigated adipokines may provide promising and novel pharmacological insights for oncological diagnosis in the near future.

Mechanical intestinal obstruction caused by displacement of a stomach balloon - case report.

Methods of treating obesity in selected cases include endoscopically performed procedures, among them endoscopically placed intragastric balloons. It is a method associated with a low complication rate, traditionally reserved to treat the most obese patients. Balloon rupture or deflation and its migration into the small bowel is one of the possible complications. In some cases, the balloon moves through the digestive tract without side effects. When the balloon's displacement in the intestine is impossible, gastrointestinal obstruction occurs. We report a case of a patient with a mechanical obstruction of the gastrointestinal tract caused by asymptomatic balloon rupture and its migration into the jejunum.

Obesity, blood rheology and angiogenesis.

Adipose tissue is actively involved in angiogenesis through secretion of biologically active substances. This topic has been the subject of many recent publications concerning the pathophysiology and treatment of obesity. We discuss the relationship between obesity, angiogenesis and blood rheology.

The effects of obesity on CD47 expression in erythrocytes.

BACKGROUND: To investigate the effects of obesity on CD47, phosphatidylserine (PS) exposure, and Caspase-8 and Caspase-3 activities in erythrocytes. METHODS: The study included 25 morbidly obese patients and 20 healthy people as the control group. We evaluated CD47 expression on the red blood cell (RBC) membrane surface and eryptosis markers such as PS externalization and caspase activity using flow cytometric analyses. RESULTS: CD47 expression on the RBC surface was significantly lower in obese patients than in the control group (P = 0.000001). We did not find significant differences in the Caspase-3 and Caspase-8 activities between the obese and nonobese control groups. Additionally, we did not find differences in PS exposure on erythrocyte membranes. The fibrinogen levels were higher in the obese group than they were in the control group (P = 0.00002). Correlations between CD47 expression and body mass index (r = -0.65; P = 0.0004), waist circumference (r = -0.54; P = 0.0052), and fibrinogen (r = 0.57; P = 0.0024) were found. Univariate analyses revealed that body mass index, waist circumference, hip circumference, and fibrinogen levels were potential predictors of CD47 expression. Multivariate analyses found that fibrinogen levels (ß = 0.4708; P = 0.045) independently predicted CD47 expression. CONCLUSIONS: The study demonstrated that CD47 expression is decreased on the surface of RBCs in obese subjects. These changes in CD47 expression on the RBC surface may be an adaptive response to hyperfibrinogenemia associated with obesity. © 2015 International Clinical Cytometry Society.

Influence of Obesity on Anastomotic Leakage After Anterior Rectal Resectionperformed Due to Cancer.

UNLABELLED: Anterior resection for rectal cancer carries the risk of serious complications, especially fistulas at the site of anastomosis. Numerous factors have been shown to impact anastomotic leakage. The results of studies on the influence of obesity on the frequency of anastomotic leakage after rectal resection performed due to cancer have been contradictory. The aim of the study was to evaluate the relationship between body mass index (BMI) and frequency of anastomotic leakage after anterior rectal resection performed due to cancer. MATERIAL AND METHODS: This retrospective analysis included 222 subsequent patients who had undergone anterior resection due to cancer with an anastomosis formed with a mechanical suture. The patients were divided into 3 groups depending on their BMI quartile as follows: Group I, BMI < 23.8 kg/m2 (lower quartile); group II, BMI between 23.8 and 29.38 kg/m2 (middle quartile); and group III, BMI > 29.38 kg/m2 (upper quartile). RESULTS: Anastomotic leakage occurred in 8 (3.6%) patients. Fistulas occurred in 4 out of 61 patients (6.56%) in group I, which was the highest incidence of fistulas for all 3 groups. In group II, fistulas occurred in 2 out of 55 patients (3.63%), and similarly, in group III, they occurred in 2 out of 106 patients (1.87%). The differences found in the frequency of fistulas between groups were not statistically significant (p=0.31). The logistic regression analysis did not show any relationship between leakage and age (p = 0.55; OR = 1.02; 95% CI: 0.95 - 1.1), sex (p = 0.97; OR = 0.97; 95% CI: 0.22 - 4.25) or BMI (p = 0.27; OR = 0.58; 95% CI: 0.22 - 1.53). CONCLUSIONS: The results of our study show that BMI did not have any influence on the frequency of anastomotic leakage after anterior rectal resection performed due to cancer.

The effects of weight loss surgery on blood rheology in severely obese patients.

BACKGROUND: The effects of dieting on blood rheology in obese individuals suggest that improving the rheologic profiles depends on the amount of weight lost and its long-term maintenance. The aim of this study was to evaluate the effects of weight loss after surgery on blood rheology at 12-month follow-up. METHODS: We studied 38 obese patients who underwent laparoscopic weight loss surgery, 22 of whom had sleeve gastrectomy (SG) and 16 of whom had gastric banding (LAGB). We evaluated rheologic parameters such as blood viscosity, plasma viscosity, and erythrocyte deformability (as measured by elongation index [EI]) preoperatively and 12 months after surgery. RESULTS: Whole blood viscosity at 150 s(-1) shear rate (P<.01) and 300 s(-1) shear rate (P<.05), blood viscosity corrected to a standard hematocrit at both shear rates (P<.0005 and P<.005, respectively), and plasma viscosity (P<.005) were significantly reduced after surgery. EI evaluated at different shear stresses (18.49-60.03 Pa) decreased (P<.005) 12 months after surgery. There were significantly decreased EI and blood viscosity corrected to a standard hematocrit after SG (P<.005 and P<.05) and LAGB (P = .0621 and P<.05), but plasma viscosity significantly decreased only after SG (P<.005). Blood viscosity at both shear rates correlated with plasma viscosity (r = .51, P<.005 and r = .5, P<.005). Plasma viscosity correlated positively with body mass index (r = .57; P<.0005) and negatively with percentage of excess weight lost (r = -.56; P< .005). CONCLUSIONS: This study found that weight loss after bariatric surgery induced improvement in blood rheology in obese patients at 12 months after surgery. The increased red blood cell rigidity after surgery requires further study because the physiologic importance of this change has not yet been established.

Literature review of non-operative management of patients with blunt splenic injury: impact of splenic artery embolization.

Splenic injuries constitute the most common injuries accompanying blunt abdominal traumas. Non-operative treatment is currently the standard for treating hemodynamically stable patients with blunt splenic injuries. The introduction of splenic angiography has increased the possibility of non-operative treatment for patients who, in the past, would have qualified for surgery. This cohort includes mainly patients with severe splenic injuries and with active bleeding. The results have indicated that applying splenic angioembolization reduces the frequency of non-operative treatment failure, especially in severe splenic injuries; however, it is still necessary to perform prospective, randomized clinical investigations.

Transcutaneous intravascular transposition of a permanent dialysis catheter.

Permanent catheters are used to provide long-lasting access for long-term dialysis therapy in certain patients when creating an arteriovenous fistula between their own vessels is not possible, when there are contraindications for fistula creation or when the expected lifetime of the patient is short. We present the case of a patient with terminal renal insufficiency treated with hemodialysis for 5 years. Due to post-thrombotic changes and venous stenosis resulting from long-term cannulation with dialysis catheters, the replacement catheter was inserted through the previously used canal and transcutaneous intravascular catheter transposition was performed.

Impact of weight loss due to sleeve gastrectomy on shear stress of the femoral vein in morbid obesity.

BACKGROUND: Studies have shown that obesity is associated with venous flow disturbances that lead to changes of the biomechanical forces on the venous wall known as shear stress. We hypothesized that weight loss due to bariatric surgery affects the venous hemodynamics and biomechanical forces on the venous wall. The aim of this study was to evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on the wall shear stress (WSS) and the venous hemodynamics of the femoral vein. METHODS: We studied ten morbidly obese patients who underwent LSG. We investigated venous hemodynamics before, 6 and 12 months after LSG. The femoral vein diameter, cross-sectional area, peak (PeakV) and maximum (TAmax) velocities, WSS, and shear rate (SR) were assessed. RESULTS: PeakV and TAmax were significantly lower in the obese patients compared with the control group. WSS and SR were significantly lower in the obese patients compared with the control subjects. Venous hemodynamic parameters increased in the postoperative period at baseline compared with 12 months after surgery: PeakV increased from 17.53 (14.25-20.01) cm/s to 25.1 (20.9-30.1) cm/s (P = 0.04) and the TAmax from 12.97 (11.51-14.6) cm/s to 18.46 (13.24-24.13) cm/s (P = 0.057). WSS significantly increased from 0.21 (0.19-0.23) Pa at baseline to 0.31 (0.23-0.52) Pa 12 months after surgery (P = 0.031). SR also significantly increased from 47.92 (43.93-58.55) s(-1) at baseline to 76.81 (54.04-109.5) s(-1) 12 months after surgery (P = 0.02). CONCLUSIONS: This study showed that weight loss due to LSG significantly changes the biomechanical forces on the femoral vein generated by blood flow.

The impacts of super obesity versus morbid obesity on red blood cell aggregation and deformability among patients qualified for bariatric surgery.

The aim of this study was to evaluate the effects of the obesity degree on red blood cell aggregation and deformability. We studied 56 obese patients before weight loss surgery who were divided into two groups: morbid obesity and super obesity. The aggregation and deformability of RBCs were evaluated using a Laser-assisted Optical Rotational Cell Analyzer (Mechatronics, the Netherlands). The following parameters specific to the aggregation process were estimated: aggregation index (AI), aggregation half-time (t1/2) and threshold shear rate (γthr). RBC deformability was expressed as erythrocyte elongation (EI), which was measured at 18.49 Pa and 30.2 Pa shear stresses. Super obese patients presented significantly higher AI (P < 0.05) and γthr (P < 0.05) and significantly lower t1/2 (P < 0.05) compared with morbidly obese individuals. Multivariate analyses showed that fibrinogen (ß 0.46, P < 0.01 and ß 0.98, P < 0.01) and hematocrit (ß 0.38, P < 0.05 and ß 1.01, P < 0.01) independently predicted the AI in morbidly obese and super obese patients. Fibrinogen (ß -0.4, P < 0.05 and ß -0.91, P < 0.05) and hematocrit (ß -0.38, P < 0.05 and ß -1.11, P < 0.01) were also independent predictors of the t1/2 in both obese groups. The triglyceride level (ß 0.32, P < 0.05) was an independent predictor of the t1/2 in the morbidly obese group. No differences in EI were observed between obese subjects. Multivariate analyses showed that the triglyceride level independently predicted EI at 18.49 Pa (ß -0.42, P < 0.05 and ß -0.53, P < 0.05) and 30.2 Pa (ß -0.44, P < 0.01 and ß -0.49, P < 0.05) in both obese groups. This study indicated that the obesity degree of patients who qualify for bariatric surgery affects RBC aggregation properties, but it does not indicate the reasons for this difference. Further studies are needed to determine factors associated with hyperaggregation in super obesity.

Association between hemorheological alteration and clinical diagnosis of metabolic syndrome among patients qualified for bariatric surgery.

This study presents the association between metabolic syndrome and hemorheological parameters among obese patients qualified for bariatric surgery. We studied 73 morbidly obese patients who were qualified for bariatric surgery. Blood and plasma viscosity measurements were performed using a cone-plate viscometer (Brookfield DV-II). RBC aggregation was measured using the Laser-assisted Optical Rotational Cell Analyser (LORCA). The following parameters for the aggregation process were estimated: aggregation index (AI), amplitude (AMP), aggregation half-time (t1/2), threshold shear rate (γthr), the fast (Tfast) and the slow (Tslow) component. Metabolic syndrome was defined according to the Adult Treatment Panel III and International Diabetes Federation criteria. The obese presented differences in all rheological properties compared to control, regardless of clinical diagnosis of metabolic syndrome, except that whole blood viscosity was higher only in the obese metabolic syndrome group. No differences among the obese with and without metabolic syndrome were observed except in hematocrit. Whole blood viscosity and corrected blood viscosity correlated positively with WHR and BMI. AI, γthr, Tslow correlated positively with BMI, WHR, total cholesterol level and low-density lipoproteins. Negative correlation presented t1/2 with BMI, WHR, fibrinogen, total cholesterol level and low-density lipoproteins. The study showed that morbid obesity is associated with hemorheological disturbances independently of clinical diagnosis of metabolic syndrome.

Surgical treatment of a rare case of granular cell tumour of the cervical oesophagus.

A female patient was operated upon due to cervical oesophageal stricture induced by a tumour located just below the throat. Local excision of the tumour and reconstruction of the oesophageal wall was performed using the pre-vertebral fascia due to the presence of extensive oesophageal mucosa damage. The patient also required temporary alimentation by the gastrostomy route due to swallowing disturbances. The oesophagram depicted a contrasting airway passage without any evidence of fistula and contrast medium leakage through the oesophageal lumen. Four months after the operation, the patient did not report any issue with oral intake. The postoperative histopathological and immunohistochemical examinations provided evidence of a granular cell tumour (GCT). We believe that local excision of the tumour should always be considered in cases of tumours located close to the throat because it is less invasive than partial resection of a GCT in the oesophagus or oesophagogastrectomy.