John Preto

c-erb B-2 Expression Is Associated with Tumor Location and Venous Invasion and Influences Survival of Patients with Gastric Carcinoma:

The HER-2/neu gene or c-erb B-2, localized on chromosome 17q, belongs to a family of tyrosine kinase receptors and shares extensive homology with the epidermal growth factor receptor. c-erb B-2 gene amplification and protein overexpression have been reported in several human cancers. The prognostic value of this genetic alteration in gastric carcinoma is far from being established. In the present study, formalin-fixed, paraffin-embedded gastric carcinoma tissues from 157 patients were evaluated for c-erb B-2 overexpression, by immunohistochemistry using a polyclonal antibody. c-erb B-2 expression was evaluated according to clinical and pathological parameters, and to the survival of the patients. Our results show that: (1) c-erb B-2 was overexpressed in 15.3% of gastric carcinoma cases; (2) c-erb B-2 overexpression was significantly more frequent in cardia (23.8%) and fundus/body (25.0%) carcinomas than in antrum (7.2%) carcinomas; (3) c-erb B-2 overexpression was significantly associated with venous invasion; (4) c-erb B-2 is a prognostic factor for gastric carcinoma.

Metabolic score: insights on the development and prediction of remission of metabolic syndrome after gastric bypass.

Introduction:Metabolic syndrome (MetS) clusters the most dangerous cardiovascular disease risk factors. Although insulin resistance and central obesity play an important role in the pathogenesis, the factors that determine its development and ultimate remission after Roux-en-Y gastric bypass (RYGB) are not fully understood. Methods:We recruited a prospective cohort of 210 consecutive patients after RYGB between January 2010 and December 2011. Patients were evaluated clinically and with a biochemical profile preoperatively and at 12 months after surgery. Visceral adipose tissue and subcutaneous abdominal adipose tissue samples were collected at surgical intervention. We aimed to identify factors associated with MetS in morbidly obese patients and predictors of its remission 12 months after RYGB. Results:Increasing age (>40 years), male sex, alanine aminotransferase levels and visceral adipose tissue/subcutaneous adipocyte size ratio were independently related to the expression of MetS at the moment of surgery.One year after RYGB, there was a significant decrease in the prevalence of MetS (63.3%–10%; P < 0.001) and in each of its components. A multivariable analysis for the remission of MetS identified that only fasting glucose levels (OR = 13.4; P = 0.01) and duration of obesity (OR = 1.08; P = 0.04) were independently related to the persistence of MetS. A metabolic score (scale of 1–10), consisting of duration of obesity, fasting blood glucose levels, the presence of high blood pressure and low levels of high-density lipoprotein identified 4 different risk categories for the persistence of MetS (area under the curve = 0.848). Conclusions:The metabolic score can be used to predict the remission of MetS after RYGB with high accuracy. Patients in high-risk groups might be managed more aggressively and low-risk patients may have their medication discontinued earlier with extra safety.

Primary gastric adenosquamous carcinoma in a Caucasian woman: a case report

IntroductionMost gastric tumors are adenocarcinomas. Primary gastric adenosquamous carcinoma is a rare malignancy, mostly associated with Asian populations. It constitutes less than one percent of all gastric carcinomas and its clinical presentation is the same as adenocarcinoma. It occurs more frequently in the proximal stomach, usually presents with muscular layer invasion and tends to be found in advanced stages at diagnosis, with a worse prognosis than adenocarcinoma.Case presentationWe report the case of an 84-year-old Caucasian woman with an adenosquamous carcinoma extending to her serosa with lymphatic and venous invasion (T3N1M1). Nodal and hepatic metastasis presented with both cellular types, with dominance of the squamous component.ConclusionsAdenosquamous gastric cancer is a rare diagnosis in western populations. We present the case of a woman with a very aggressive adenosquamous carcinoma with a preponderance of squamous cell component in the metastasis. Several origins have been proposed for this kind of carcinoma; either evolution from adenocarcinoma de-differentiation or stem cell origin might be possible. The hypothesis that a particular histological type of gastric cancer may arise from stem cells might be a field of research in oncological disease of the stomach.

Age and Weight Loss After Bariatric Surgery: Cause or Consequence?

In spite of its indisputable role in the treatment of obesity,bariatric surgery is not absent of cutbacks and complica-tions. Cumulative experience is allowing the discovery offactors associated with weight loss after bariatric surgery[1], which may allow the development of more selectiveand effective interventions. In this regard, both Contreraset al. [2] and Scozzari et al. [3] reports bring an importantcontribution, by clearly showing that patients’ age nega-tively associates with success in weight loss. In the dis-cussion of their results, the authors consider a range offacts possibly interfering with weight loss in people ofmore advanced age: from differences in energy require-ments to social and psychological aspects and, probably ofgreat importance, an impaired metabolic capacity and alower lipolytic activity.Results obtained by our group [4], in a sample of 163obese patients, showed that, in good agreement with theresults of Scozzari et al., younger patients (<50 years)achieved a greater weight loss after 12 months of follow-up (80 % excess weight loss (EWL) vs 70 % EWL; p=0.01). More interestingly, in the preoperative period and incomparison with older patients, younger (and most respon-sive) patients had significantly lower fasting glucose levels(93 vs 111 mg/dL; p<0.001) [4] and were less contaminat-ed with persistent organic pollutants (POPs) in visceraladipose tissue (168.9±13.7 ng/g of fat vs 311.0±32.7 ng/goffat,p<0.0001) [POPs data to be published]. Specifi-cally in our analysis, the effect of age disappeared afteradjustment for fasting blood glucose levels.As both higher fasting glucose [ 5] levels and higher levels ofPOPs [6] in adipose tissue will decr ease lipolysis, this seems tobe a most important mechanism behind the difficulty of olderpeople to respond to weight-los ing interventions. It would beinteresting to study the influence of age on weight loss by otherinterventions and to further evaluate the capacity of fastingglucose and POPs levels to predict weight loss independentlyof age.