Abstract-Remodeling of the resistance arteries is a hallmark of arterial hypertension and predicts cardiovascular events, but it was unknown whether it could also predict the blood pressure response to adrenalectomy of patients with an aldosterone-producing adenoma. Therefore, we investigated the outcome of adrenalectomy as a function of vascular remodeling in the context of the preoperative features of aldosterone-producing adenoma patients. At 2 referral centers for hypertension, we prospectively measured the media:lumen ratio of small arteries from fat tissue of 50 consecutive aldosterone-producing adenoma patients treated with adrenalectomy. The blood pressure response to adrenalectomy was assessed by considering the blood pressure values and the number and dosages of antihypertensive medications. Adrenalectomy significantly (PϽ0.001) lowered plasma aldosterone (from 27.3Ϯ4.9 ng/dL to 8.3Ϯ11.2 ng/dL), the aldosterone:renin ratio (from 117Ϯ35 to 11Ϯ2), and blood pressure (from 163Ϯ22/98Ϯ2 mm Hg to 133Ϯ2/ 84Ϯ1 mm Hg), even despite a reduction (from 141Ϯ14 to 100Ϯ15; Pϭ0.02) of the score of antihypertensive treatment.It provided cure of hypertension in 30% of the aldosterone-producing adenoma patients, normotension with less antihypertensive therapy in 52%, and improved blood pressure control in the rest. The media:lumen ratio and the known duration of hypertension significantly predicted the blood pressure response to adrenalectomy at univariate and multivariate analyses. Because a long duration of hypertension and/or the presence of vascular remodeling imply lower chances of blood pressure normalization at long-term follow-up postadrenalectomy, these findings emphasize the importance of an early diagnosis of aldosterone-producing adenoma. Key Words: secondary hypertension Ⅲ aldosterone Ⅲ aldosteronism Ⅲ adrenalectomy Ⅲ outcome Ⅲ vascular remodeling P rimary aldosteronism (PA) is far more common than usually perceived and is attributable to an aldosteroneproducing adenoma (APA) in approximately half of the patients. 1 Thus, it entails the most common endocrine form of secondary arterial hypertension (HT) that is curable by adrenalectomy in many patients. 2 Identification of an APA, or unilateral primary adrenocortical hyperplasia, 3 requires adrenal vein sampling (AVS) that, being minimally risky, should be reserved for patients who are candidates for adrenalectomy and, more importantly, can benefit from it. 4 However, the identification of patients who will benefit more remains a challenging task, because the blood pressure (BP) response to adrenalectomy varies widely across patients. In fact, despite many efforts over the years, only age and lack of family history of HT were suggested to significantly predict the BP response. 5-8 Nevertheless, the large uncertainties in the prediction estimates render them of little, if any, 8 value on an individual basis.The remodeling of resistance arteries is a hallmark of arterial HT and can be implicated in the excess cardiovascular damage associated with HT. Hence, it ...

Adjuvant mitotane is associated with prolonged RFS, without any apparent influence by the tumor secretory status. The retrospective nature of the study is a major limitation.

Our results indicate that, in small resistance arteries of patients with primary aldosteronism, a pronounced fibrosis may be detected, even more evident than in blood-pressure-matched patients with essential hypertension.

Abstract-The amI of our study was to evaluate the relatlonshlps between endothehal function, small resistance artery structure, and blood pressure m patients with primary or secondary hypertension Sixty subJects were included m the study 9 patients with pheochromocytoma, 10 with primary aldosteromsm, 17 with renovascular hypertension, and 13 with essential hypertension with 11 normotenslve subjects who served as controls Chmc and 24-hour ambulatory blood pressure (ABPM) were evaluated All subjects were submitted to a biopsy of subcutaneous fat Small resistance arteries were dissected and mounted on a mlcromyograph and the media/lumen ratio was calculated A dose-response curve to acetylcholme was performed at cumulative concentrations from lo-" to 10m5 mol/L The vasodllator response to acetylcholme was slmllarly Impaired m the four groups of hypertensive patients (ANOVA P< 05 versus normotenslve controls), without any significant difference among them In subcutaneous small arteries of patients with either primary aldosteromsm or renovascular hypertension, a marked increase m media lumen ratio was observed, whrle m patients with pheochromocytoma, the extent of vascular structural alterations was similar to that observed m essential hypertension No slgmficant correlation between media-lumen ratio or chmc blood pressure and maximum acetylcholme-induced vasodllatatlon was observed On the contrary, a significant, albelt not very close, correlation between ABPM values and maximum acetylchohne-induced vasodllatatlon was observed (r=34, P< 05 with 24-hour systolic blood pressure, r=O 36, P< 05 with 24-hour dlastohc blood pressure) In conclusion, endothehal dysfunction seems to be mdependent from the degree of vascular structural alterations and from the etiology of hypertension, and it 1s probably more linked to the hemodynamlc load (Hypertension. 1998;31[part 2]:335-341.)Key Words: acetylcholme n endothelmm w EDRF n nitric oxide I vascular resistance w hypertrophy n secondary hypertension E ndothehal cells are known to have important regulatory effects on the cardiovascular system through the release of vasodllator and vasoconstnctor mediators " In small resistance arteries, endothehum seems to have a key role m the imbalance between vasoconstnctlon and vasodllatatlon ' An impairment of the endothehal function, as evaluated by the vasodllator response to acetylcholme, has been detected m human small resistance arteries both m essentla13" and m secondary hypertension ' 5Structural abnormahtles of the media of the resistance vessels are common accompamments of chronic hypertension, and they play an Important role m the mcrease of vascular reststance, and, therefore, m the maintenance of high blood pressure values " We have previously demonstrated that the extent and the charactenstlcs of structural alterations observed m subcutaneous small resistance arteries of patients with primary or secondary forms of hypertension are not umform 4 In particular, m patients with either primary aldosteromsm or renovascular hypertension,...

A noninvasive and easily repeatable procedure (intraobserver and interobserver variation coefficient <13%) such as an evaluation of the arterioles in the fundus oculi by SLDF may provide similar information regarding microvascular morphology compared with an invasive, accurate and prognostically relevant micromyographic measurement of media-to-lumen ratio of subcutaneous small arteries.

Background The aim of this study is to report the experience with conversion surgery from six Gruppo Italiano Ricerca Cancro Gastrico (GIRCG) centers, focusing our analysis on factors affecting survival and the risk of recurrence. Methods A retrospective, multicenter cohort study was performed in patients who had undergone conversion gastrectomy between 2005 and 2017. Data were extracted from a GIRCG database including all metastatic gastric cancer patients submitted to surgery. Only stage IV unresectable tumors/metastases which became resectable after chemotherapy were included in this analysis. Results Forty-five resected M1 patients were included in the analysis. Reasons for being deemed unresectable at diagnosis were peritoneal involvement (PCI > 6) (n = 38, 84.4%), distant metastatic nodes (n = 3, 6.6%) and extensive liver involvement (n = 4, 8.8%). Median follow-up was 25 months (IQR 9-50). Median overall survival from surgery was 15 months and 1-, 3-and 5-year survivals were 57.2, 36.1 and 24%, respectively. Median progression-free survival was 12 months with 1-and 3-year survival of 46.4 and 33.9%, respectively. At cox regression analysis the only independent prognostic factor for OS was the presence of more than one type of metastasis (HR 4.41,, p = 0.002). A positive microscopic resection margin was the only risk factor for recurrence (HR 5.72, 95% CI 1.04-31.4, p = 0.045). Conclusions Unresectable stage IV GC patients could benefit from radical surgery after chemotherapy and achieve long survivals. The main prognostic factor for these patients was the presence of more than one type of extra-gastric metastatic involvement.

Background Laparoscopic adrenalectomy for pheochromocytoma remains subject of debate, owing to the systemic consequences of pneumoperitoneum in patients with catecholamine-secreting tumors. Methods A prospective randomized study was conducted (2000)(2001)(2002)(2003)(2004)(2005)(2006), evaluating cardiovascular instability during open (n = 9, group A) or laparoscopic (n = 13, group B) adrenalectomy for pheochromocytoma. Haemodynamic parameters were recorded by invasive monitoring. Results Haemodynamic instability was observed in 3/9 (group A) and 6/13 patients (group B), with a mean of 1.8 and 2.2 hypertensive peaks per patient (p = n.s.). Blood loss (164 ± 94 cc versus 48 ± 36 cc, p \ 0.05) and operative time (180 ± 40 versus 158 ± 45 min, p = n.s.) favored laparoscopic procedures. Postoperative morbidity and mortality were nil. Hospital stay was shorter in group B (p \ 0.05). Long-term follow-up was always normal.Conclusions Laparoscopic approach for pheochromocytoma can be as safe as open surgery; intraoperative haemodynamic instability, although usually controlled with success, remains a source of concern.

An evident endothelial dysfunction was detected in patients with NIDDM, and the simultaneous presence of EH did not seem to exert an additive effect. The contractile responses to endothelin-1 were reduced possibly as a consequence of ET(A) receptor down-regulation.