Search

Background: For stage III or IVa thymic tumours, a multimodality approach is recommended. The role of surgery is to achieve complete resection.Aim: To present the outcomes of patients undergoing surgery for stage III or IVa thymoma.Methods: Retrospective review of patients undergoing open surgery for stage III or IVa thymoma between 2016 and 2020 at a single centre was performed. Preoperative imaging, treatment plan, surgical approach, and postoperative outcomes were analyzed.Results: Forty-seven patients underwent surgery for thymoma. Patients with clinical stage I/II thymoma or minimally invasive thymectomy were excluded. Thirteen patients with clinical stage III or IVa were included. Median sternotomy approach was used in four patients, of which one was redo sternotomy; a hemi-clamshell in four; and a combination of approaches in the remaining five patients. There was no postoperative mortality. Four patients had postoperative complications. Complete resection was achieved in all but two patients. At a median follow-up of 17.9 months, all patients were alive with no evidence of recurrence except one who died 4 months after surgery from coronavirus disease 2019 (COVID-19) pneumonia.Conclusions: Surgery for stage III and IVa thymoma is safe and can be achieved with complete macroscopic resection. To obtain adequate exposure of all structures involved in the tumour, combined surgical approaches can be used with no increased morbidity. The majority of patients, even after extrapleural pneumonectomy, did not receive adjuvant radiotherapy and had no evidence of local relapse.

Hyperglycemia was reported to enhance angiotensin (Ang) II generation in rat cardiomyocytes, and Ang II inhibition reduces cardiovascular morbidity and mortality in diabetic patients. In diabetic patients, the enhanced activation of intracellular pathways related with myocyte hypertrophy and gene expression might enhance the progression of cardiac damage. Therefore, we investigated the effects of glucose on Ang II-mediated activation of Janus-activated kinase (JAK)-2, a tyrosine kinase related with myocyte hypertrophy and cytokine and fibrogenetic growth factor overexpression, in ventricular myocytes isolated from nonfailing human hearts (n = 5) and failing human hearts (n = 8). In nonfailing myocytes, JAK2 phosphorylation was enhanced by Ang II only in the presence of high glucose (25 mmol/l) via Ang II type I (ATI) receptors (+ 79% vs. normal glucose, P < 0.05). JAK2 activation was prevented by inhibitors of reactive oxygen species (ROS) generation (diphenyleneiodonium [DPI], tiron, and apocynin). In myocytes isolated from failing hearts, JAK2 phosphorylation was enhanced by high glucose alone (+107%, P < 0.05). High glucose-induced JAK2 activation was blunted by both ACE inhibition (100 nmol/l ramipril) and AT1 antagonism (1 µmol/l valsartan), thus revealing that the effects are mediated by autocrine Ang II production. Inhibition of ROS generation also prevented high glucose-induced JAK2 phosphorylation. In conclusion, in human nonfailing myocytes, high glucose allows Ang II to activate JAK2 signaling, whereas in failing myocytes, hyperglycemia alone is able to induce Ang II generation, which in turn activates JAK2 via enhanced oxidative stress., In patients with diabetes and abnormal glucose tolerance, left ventricular hypertrophy is often detectable (1,2) and diastolic dysfunction is highly prevalent (3). Diabetic cardiomyopathy, characterized by both myocyte hypertrophy and [...]

Background. Complete surgical resection represents one of the most important prognostic factors for thymomas. However, surgery is usually not considered when there is invasion of the pulmonary hilum and mediastinal veins because of technical considerations or potential perioperative morbidity and mortality. Case Presentation. We present the case of a 37-year-old woman with a giant thymoma infiltrating the superior vena cava, left brachiocephalic vein, and most of the right lung. Following 3 cycles of chemotherapy with minimal tumour response, she was hospitalised with COVID-19 and refused further systemic treatment. She subsequently underwent surgery after a thorough preoperative evaluation. Surgical resection of the tumour was performed with concomitant right pneumonectomy and reconstruction of the superior vena cava and left brachiocephalic vein using expanded-polytetrafluoroethylene grafts through a median sternotomy combined with a clamshell incision. Histopathological analysis of the resected specimens demonstrated a type B2, Masaoka-Koga stage IVa thymoma that was completely resected. Following an uneventful course, she was discharged home on the ninth postoperative day with anticoagulation therapy. She has remained free of disease or adverse events after a 12-month follow-up. Conclusions. Complete surgical resection of invasive thymomas with concomitant pneumonectomy and venous graft reconstruction is a feasible and safe procedure. Careful patient selection and adequate postoperative anticoagulation are crucial for successful clinical outcomes.

Angiotensin II was reported to induce insulin-like growth factor-I and endothelin-1 gene expression and peptide release by ventricular cardiomyocytes. However, the progression from cardiac hypertrophy to failure in humans is characterized by a reduced myocyte expression of insulin-like growth factor-I and endothelin-1, notwithstanding the enhanced cardiac generation of angiotensin II. In the present study we investigated the functional status of the signaling pathways responsible for angiotensin II-induced endothelin-1 and insulin-like growth factor-I formation in human ventricular myocytes isolated from patients with dilated (n19) or ischemic (n14) cardiomyopathy and nonfailing donor hearts (n6).

Objective: To investigate and identify the prognostic indicators of cardiac surgical outcomes in patients with pulmonary hypertension (PH) with or without right ventricle (RV) dysfunction.Methods: In this retrospective observational study, all the patients with preoperative PH who underwent isolated mitral valve and tricuspid valve surgery from May 2011 to December 2019, were enrolled in the study (n=80, age 66.7±13.4 yo). This cohort was then classified as Group 1 (RV dysfunction; n=27, 34%) and Group 2 (RV normal; n=53, 66%), according to the function of the RV. PH was defined as a mean pulmonary arterial pressure (mPAP)≥25mmHg, or pulmonary artery systolic pressure (PASP)≥38mmHg. RV dysfunction was defined based on American Society of Echocardiography guidelines.Results: The cumulative mortality at 30 days was 11% (n=9) with no statistical difference between the two groups (Group 1: n=4, 15%; Group 2: n=5, 9%; x2= 1.23, p=0.266). Instead, a significant difference in the mortality rate was observed between the type of surgery performed: mitral valve replacement and tricuspid valve repair was associated with higher mortality rate (n=8, 23%; x2= 7.01, p=0.030) when compared with mitral repair. In univariate analysis, RV dysfunction was correlated with a lower ejection fraction (61.4±10 vs 55.6±10, p=0.017), higher incidence of respiratory failure (OR:9; CI:0.9-85; p=0.042) and higher length of stay (median 8 days (IQR:1-25), p=0.042). The type of surgery was a predictor risk in a Cox regression analysis (Hazard ratio: 0.08; CI:0.01-0.7; p=0.022).Conclusions: In patients with PH and/or RV dysfunction, mitral valve replacement alone represents an independent risk factor for mortality, irrespective of the aetiology. RV dysfunction is related to longer length of stay and incidences of peri-operative morbidity.