The relationship between incomplete surgical obliteration of the left atrial appendage and thromboembolic events after mitral valve surgery (from the ISOLATE Registry).

Left atrial appendage (LAA) is a common site of thrombus formation especially in patients with atrial fibrillation (AF). Complete surgical LAA closure (cSLC) is the surgical aim, however incomplete surgical LAA closure (iSLC) is not rare. In this study, we aimed to evaluate the risk of thromboembolic complications (TEC) in AF patients with iSLC after mitral valve surgery. A total of 101 AF patients (mean age: 61.8 ± 11.8 years; male:32), who underwent surgical suture ligation during mitral valve surgery were enrolled in this retrospective study. All patients underwent transthoracic and transesophageal echocardiography (TEE) at least 3 months after surgery. The primary outcome was the occurrence of TEC including any ischemic stroke, transient ischemic attack, coronary or peripheral embolism. TEE examination revealed cSLC in 66 (65.3%) and iSLC in 35 patients (34.6%). A total of 12 TECs (11.9%) occurred during a mean follow-up time of 41.1 ± 15.6 months. TECs were found to be significantly higher in the iSLC group (25.7% vs 4.5%, p = 0.002). The prevalence of iSLC was significantly higher in patients with TEC (75 vs. 29.2%, p = 0.002). High CHA2DS2-VASc Score and iSLC were found to be independent predictors of TEC. Long term TEC free survival was found to be significantly decreased in patients with iSLC. The presence of iSLC was associated with a significantly increased risk of TEC in AF patients after mitral valve surgery. Routine intraoperative and postoperative screening for iSLC by TEE and long-term strict anticoagulation therapy are recommended in these patients.

Infrequent Tumors of the Gastrointestinal Tract Including Gastrointestinal Stromal Tumor (GIST).

The scientific basis of the use of FDG-PET in the diagnosis and management of patients with malignancies has been well established since the 1990s. This nuclear medicine imaging technique plays an essential role in the management of many cancers including lung cancer, breast cancer, lymphoma, melanoma, and various gastrointestinal malignancies, such as colorectal cancer and esophageal cancer. This article focuses on the use of FDG-PET in tumors of the gastrointestinal system that are less frequently encountered, such as gastrointestinal stromal tumor, gallbladder carcinoma, gastric lymphoma, and intrapapillary mucinous neoplasm of the pancreas.

FDG-PET to Measure Response to Targeted Therapy: The Example of Gastrointestinal Stromal Tumor and Imatinib Mesylate (Gleevec).

Imaging has played a major role in the evaluation of molecular targeted therapies in patients with gastrointestinal stromal tumors. FDG-PET has been instrumental in the evaluation of the tyrosine kinase inhibitors used to treat this disease. Imaging findings on FDG-PET and CT have illustrated the need to re-evaluate traditional response assessment criteria. Because most PET studies are now performed on hybrid PET/CT scanners, there is an opportunity to test and validate existing and new PET tracers and to provide anatomic and functional information in one setting. The inclusion of imaging in the testing and implementation of targeted therapies is helping to define the concept of personalized medicine.