Mitochondrial genetic effect on atrial fibrillation: A case-control study.

Atrial fibrillation (AF) is a common arrhythmia in the general population and following cardiac surgery. The influence of mitochondrial genomics on AF pathogenesis is not fully understood. We analyzed mitochondrial variables from 78 human atrial samples collected from cardiac surgeries in the following groups: 1) permanent preoperative AF; 2) preoperative sinus rhythm (SR) with postoperative AF; and 3) pre-/postoperative SR. Haplogroup H appeared offer protection against, and haplogroup U predispose to permanent AF. mtDNA content was higher in group 2 than in 3. These findings contribute to a better understanding of the influence of mitochondria on AF pathogenesis.

Hemorragia digestiva aguda en paciente con neurofibromatosis tipo 1 afecto de múltiples GIST y ganglioneuromatosis intestinal / Acute gastrointestinal bleeding, multiple GIST and intestinal ganglioneuromatosis in a patient with neurofibromatosis

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Leiomyosarcoma of the Right Gonadal Vein: Review of the Approach and Prognostic in a Rare Case.

BACKGROUND: Venous leiomyosarcoma is a mesenchymal tumour that represents 5-7% of soft tissue sarcomas. It originates in the smooth muscle cells of the vessel wall and is frequently located in the inferior vena cava. Primary leiomyosarcomas of the gonadal vein are rare, with only 10 cases reported in the literature. CASE REPORT: We present the case of a 51-year-old woman diagnosed with a right retroperitoneal mass by computed tomography (CT). The differential diagnosis was between a neurogenic tumour and a mesodermic tumour. The tumour was dissected from the vena cava and right ureter by laparoscopy without performing resection en bloc. Histologic examination of the surgical specimen showed a high-grade leiomyosarcoma of the right gonadal vein. The postoperative course was uneventful. Three cycles of chemotherapy with epirubicin-ifosfamide were performed. DISCUSSION AND CONCLUSIONS: Venous leiomyosarcoma is an aggressive tumour, and prognosis is poor due to haematogenous spread. No chemotherapy or radiotherapy has yet proven effective in improving survival, and complete surgical excision is currently considered to offer the best chance of cure. Despite the more conservative treatment approach used in the present case, the patient is alive three years after surgery and has a good quality of life. Although it was not used in this patient, the standard procedure for optimal survival is resection en bloc.

Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS).

Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. Wide excision is the mainstay of treatment for localized sarcoma, and associated preoperative or postoperative radiotherapy should be administered in high-risk patients. Adjuvant chemotherapy was associated with a modest improvement in survival in a meta-analysis and constitutes a standard option in selected patients with high-risk STS. In metastatic patients, surgery must be evaluated in selected cases. In the rest of patients, chemotherapy and, in some subtypes, targeted therapy often used in a sequential strategy constitutes the treatment of election. Despite important advances in the understanding of the pathophysiology of the disease, the advances achieved in therapeutic results may be deemed still insufficient. Moreover, due to the rarity and complexity of the disease, the results in clinical practice are not always optimal. For this reason, the Spanish Group for Research on Sarcoma (GEIS) has developed a multidisciplinary clinical practice guidelines document, with the aim of facilitating the diagnosis and treatment of these patients in Spain. In the document, each practical recommendation is accompanied by level of evidence and grade of recommendation on the basis of the available data.

Resección hepática por hepatocarcinoma: estudio comparativo entre pacientes menores y mayores de 70 años / Hepatic resection in hepatocarcinoma: A comparative study between patients under and over 70 years-old

Introducción: El manejo quirúrgico agresivo de ciertos tipos de tumores es cuestionado en el paciente anciano debido a la posibilidad de tener un aumento en la morbimortalidad. Este es el caso del paciente anciano con carcinoma hepatocelular. Comparamos los resultados obtenidos con la resección hepática entre pacientes mayores y menores de 70 años de edad con hepatocarcinoma. Material y métodos Se realizaron 36 resecciones hepáticas curativas para tratar cáncer hepatocelular. Dividimos nuestra población en 2 grupos (14 pacientes < 70 años y 22 pacientes ≥ 70 años de edad) y comparamos su morbimortalidad, periodo libre de enfermedad y sobrevida global utilizando curvas de Kaplan-Meir y prueba de log rank. Además buscamos factores de mal pronóstico en la población. Resultados Ambos grupos son similares en cuanto al estado pre-operatorio. El tiempo quirúrgico, tipo de procedimiento, estancia hospitalaria y morbimortalidad fueron similares. La sobrevida global para los pacientes jóvenes y seniles a 3 y 5 años fue de 85,7 vs. 68,7% y 47,6 vs. 60% respectivamente (p=0,813). El periodo libre de enfermedad a 3 y 5 años fue de 69,3 vs. 35,2% y 39,6 vs. 23,4% respectivamente (p=0,539). El análisis multivariado reveló la enfermedad multicéntrica y la alfa-feto-proteína elevada como factores pronósticos independientes de una sobrevida libre de enfermedad y global más cortas. Conclusión Los pacientes mayores de 70 años con carcinoma hepatocelular deben ser manejados en una manera similar a pacientes más jóvenes. Hay que tomar en cuenta factores de mal pronóstico como la multicentricidad y la alfa-feto-proteína elevadas (AU)

Introduction: The ageing population raises concerns about the adequacy of aggressive surgical procedures and their outcomes. The treatment of the elderly with hepatocellular carcinoma is one of the diseases that involve complicated management decisions. We set out to compare the results between an older and younger patient cohort with this disease are compared. Material and methods: A total of 36 hepatic resections were performed on patients with hepatocellular carcinoma between 2000 and 2011. The cohort was divided into 2 groups (14patients < 70 and 22 patients 70 years of age), and their results, disease free and overall survival were compared using Kaplan-Meir curves and log rank test. An attempt was also made at determining the predictive factors of a poor outcome among this patient cohort. Results: Both groups were similar with regards to their pre-operative status. Operation time, procedure, hospital stay, and morbidity and mortality were similar. Overall survival at 3and5 years comparing the younger vs. the elderly group was 85.7% vs. 68.7% and 47.6% vs. 60%,respectively (P =.813). Disease free survival at 3 and 5 years comparing the younger vs. the elderly group was 69.3% vs. 35.2% and 39.6% vs. 23.4%, respectively (P =.539). Multivariate analysis of the whole cohort revealed multicentric diseases and elevated alpha-fetoproteinas independent factors of poor disease free survival and overall survival, respectively. Conclusions: Elderly patients with hepatocellular carcinoma should be managed in a similar fashion to younger patients. Surgeons should expect similar post-operative complications, disease free and overall survival (AU)

[Hepatic resection in hepatocarcinoma: a comparative study between patients under and over 70 years-old]. / Resección hepática por hepatocarcinoma: estudio comparativo entre pacientes menores y mayores de 70 años.

INTRODUCTION: The ageing population raises concerns about the adequacy of aggressive surgical procedures and their outcomes. The treatment of the elderly with hepatocellular carcinoma is one of the diseases that involve complicated management decisions. We set out to compare the results between an older and younger patient cohort with this disease are compared. MATERIAL AND METHODS: A total of 36 hepatic resections were performed on patients with hepatocellular carcinoma between 2000 and 2011. The cohort was divided into 2 groups (14 patients < 70 and 22 patients ≥ 70 years of age), and their results, disease free and overall survival were compared using Kaplan-Meir curves and log rank test. An attempt was also made at determining the predictive factors of a poor outcome among this patient cohort. RESULTS: Both groups were similar with regards to their pre-operative status. Operation time, procedure, hospital stay, and morbidity and mortality were similar. Overall survival at 3 and 5 years comparing the younger vs. the elderly group was 85.7% vs. 68.7% and 47.6% vs. 60%, respectively (P=.813). Disease free survival at 3 and 5 years comparing the younger vs. the elderly group was 69.3% vs. 35.2% and 39.6% vs. 23.4%, respectively (P=.539). Multivariate analysis of the whole cohort revealed multicentric diseases and elevated alpha-fetoprotein as independent factors of poor disease free survival and overall survival, respectively. CONCLUSIONS: Elderly patients with hepatocellular carcinoma should be managed in a similar fashion to younger patients. Surgeons should expect similar post-operative complications, disease free and overall survival.

Ictericia obstructiva secundaria a coágulo en vía biliar originado en colangiocarcinoma intrahepático / Obstructive jaundice secondary to a clot in the biliar y duct originating from an intrahepatic cholangiocarcinoma

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Laparoscopic resection of clinically suspected gastric stromal tumors.

Gastrointestinal stromal tumors (GISTs) account for 5% of all gastric tumors. Preoperative diagnosis is relatively difficult because biopsy samples are rarely obtained during fibergastroscopy. Surgical radical resection is the gold standard treatment, allowing pathologic study for both diagnosis and prognosis. Laparoscopic resection has become an alternative to the open approach, but long-term results are not well known. The aim of this study is to report experience with laparoscopic resection, placing special emphasis on preoperative diagnosis and describing long-term results. A retrospective analysis was made of all patients undergoing a laparoscopic resection for clinically suspected gastrointestinal stromal tumors between November 1998 and August 2006 at 2 tertiary hospitals. The medical records of all participants were reviewed regarding surgical technique, clinicopathologic features, and postoperative long-term outcome. Laparoscopic gastric resection was attempted in 22 patients (13 women and 9 men) with a mean age of 66.7 years (range, 29-84 years). One patient had 2 gastric tumors. Tumor localization was upper gastric third in 6 patients, mid-gastric third in 7, and distal third in 10. Surgical techniques were transgastric submucosal excision (n = 1), wedge resection (n = 13), partial gastrectomy with Y-en-Roux reconstruction (n = 6), and total gastrectomy with Y-en-Roux reconstruction (n = 2). Two patients (9.1%) required conversion to the open procedure because of tumor size. Postoperative morbidity was delayed gastric emptying in 3 patients. Median postoperative stay was 6 days (range, 4-32 days). Pathologic and immunohistochemical study confirmed gastrointestinal stromal tumors in 18 cases. The other 4 cases were adenomyoma, hamartoma, plasmocytoma, and parasitic tumor (anisakis). Median tumor size was 5.6 cm (range, 2.5-12.5 cm) in cases of gastrointestinal stromal tumors. Malignant risk of gastrointestinal stromal tumors assessed according to mitotic index and size was low (n = 8), intermediate (n = 6), or high (n = 4). After a median follow-up of 32 months (range, 1-72 months), there was 1 case of recurrence of GIST. Definitive preoperative diagnosis of gastric submucosal tumors is frequently difficult. The laparoscopic approach to surgical treatment of these tumors seems safe and is associated with acceptable intermediate-term results, especially in cases of gastrointestinal stromal tumors.

Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer.

BACKGROUND & AIMS: One of the most frequent complications in patients with cancer and malnutrition is the surgical wound healing delay or failure. Some studies have shown that arginine improves wound healing in rodents and in healthy human beings. The main objective of this study was to assess the effect of early postoperative enteral immunonutrition on the wound healing process in patients undergoing surgery for gastric cancer. METHODS: Sixty six patients with gastric cancer were randomized to receive early postoperative enteral immunonutrition (formula supplemented with arginine, omega-3 fatty acids and ribonucleic acid (RNA)) or an isocaloric-isonitrogenous control. Assessment of wound healing process: (1) Quantification of hydroxyproline deposition in a subcutaneously placed catheter, (2) occurrence of surgical wound healing complications. RESULTS: Sixty patients were analyzed. Patients fed with immunonutrition (n=30) showed higher local hydroxyproline levels (59.7 nmol (5.0-201.8), vs. 28.0 nmol (5.8-89.6) P=0.0018) and significantly lower episodes of surgical wound healing complications (0 vs. 8 (26.7%) P=0.005) when compared to patients fed with the control formula (n=30). CONCLUSIONS: Early postoperative enteral nutrition with a formula supplemented with arginine, omega 3 fatty acids and RNA increased hydroxyproline synthesis and improved surgical wound healing in patients undergoing gastrectomy for gastric cancer.