Surgery for sporadic abdominal desmoid tumor: is low/no recurrence an achievable goal?

BACKGROUND: Sporadic abdominal desmoid tumors are rare and data on these tumors as a distinct disease entity are lacking. Previous abdominal surgery, trauma, pregnancy and estrogen intake are considered risk factors. Although desmoids are benign, invasion and a high recurrence rate are common. OBJECTIVES: To evaluate outcomes of surgery for this rare disease. METHODS: Since 1995, 16 patients with pathologically confirmed desmoid tumor were operated on in our center. All familial adenomatous polyposis patients were excluded. A retrospective analysis of data was performed. RESULTS: Of the 16 patients 12 (75%) were females. Mean age was 40.5 years (range 24-70). Thirteen patients were symptomatic and 3 were incidentally diagnosed. All patients presented with an isolated mass; 7 (50%) originated in the abdominal wall, 6 (37.5%) were retroperitoneal and 3 were (18.8%) mesenteric. All tumors except one were completely excised. Morbidity was low with no mortality. One patient was reoperated due to involved margins. None of the patients had recurrence within a median follow-up of 64 months (range 5-143). CONCLUSIONS: The perception of sporadic abdominal desmoids as tumors with a high recurrence rate (20-70%) is probably incorrect. Adequate surgery with wide margins leads to a very low recurrence rate; cure is a legitimate goal.

Platelet counts and platelet activation markers in obese subjects.

OBJECTIVE: In this work we studied the correlation between platelet count, platelet activation, and systemic inflammation in overweight, obese, and morbidly obese individuals. METHODS AND SUBJECTS: A total of 6319 individuals participated in the study. Complete blood counts, high sensitivity C-reactive protein (hs-CRP) serum levels, and body mass index (BMI) were measured during routine checkups. Platelet activation markers were studied among 30 obese (BMI = 41 +/- 8 kg/m(2)) and 35 nonobese (BMI = 24 +/- 3 kg/m(2)) individuals. Platelet activation status was evaluated by flow cytometry using specific antibodies against the activated platelet membrane glycoprotein IIb/IIIa, p-selectin (CD-62 p), and binding of Annexin-V to platelet anionic phospholipids. RESULTS: Overweight, obese, and morbidly obese females had significantly elevated platelet counts ( P < .0001) compared with normal-weight females. No significant elevation of platelet counts was observed in the male subgroups. A significant age adjusted correlation between BMI and platelet counts ( P < .0001) was found among females. This correlation was attenuated (P = .001) after adjustment for hs-CRP concentrations. The flow cytometry analysis of platelets showed no significant differences in activation marker expression between nonobese and obese individuals. DISCUSSION: Obesity may be associated with elevated platelet counts in females with chronic inflammation. Obesity is not associated with increased platelet activation.

The degree of red blood cell aggregation on peripheral blood glass slides corresponds to inter-erythrocyte cohesive forces in laminar flow.

OBJECTIVE: To determine the degree of correlation between red blood cell (RBC) aggregation on peripheral blood glass slides (PBGS) as determined by image analysis and the inter-erythrocytic cohesive forces as determined in a computerized cell flow properties analyzer (CFA). STUDY DESIGN: RBC aggregation was assessed using both systems simultaneously in healthy volunteers, obese patients and hypercholesterolemic individuals before and following LDL apheresis. RESULTS: A significant (r = 0.5, p < 0.001) correlation was noted between the flow-dependent average aggregate size (AAS) obtained in the CFA and the degree of RBC aggregation on peripheral blood glass slides. Moreover, the enhanced RBC aggregation on the slides was positively associated with the appearance of larger aggregates in the CFA (r = 0.5, p < 0.001) and inversely with the formation of smaller aggregates (r = -0.27, p < 0.04). A similar reduction in RBC aggregation following LDL apheresis was noted in both systems. CONCLUSIONS: The phenomenon of RBC aggregation on peripheral blood glass slides is governed by significant inter-erythrocytic cohesive forces and is not a result of a mere coincidental superimposition of cells. The slide test offers a rapid and simple method of evaluating rheologically significant RBC aggregation, and may allow stratification of patients at risk for atherothrombosis.

Enhanced erythrocyte adhesiveness/aggregation in obesity corresponds to low-grade inflammation.

OBJECTIVE: Previous studies have suggested that obesity enhances the inflammatory response, producing macromolecules involved in the induction and/or maintenance of increased erythrocyte aggregation. The objectives of this study were to evaluate the correlation between inflammation markers, erythrocyte adhesiveness/aggregation, and the degree of obesity and to assess phosphatidylserine expression on erythrocyte surface membrane of obese vs. nonobese individuals. RESEARCH METHODS AND PROCEDURES: Erythrocyte adhesiveness/aggregation in the peripheral venous blood was evaluated by using a new biomarker, phosphatidylserine expression was assessed by means of flow cytometry, and markers of inflammation were measured in 65 subjects: 30 obese [body mass index (BMI) = 41 +/- 7.7 kg/m(2)] and 35 nonobese (BMI = 24 +/- 2.7 kg/m(2)) individuals. Pearson correlations and Student's t test were performed. RESULTS: A highly significant difference was noted in the degree of erythrocyte adhesiveness/aggregation and markers of inflammation between the study groups. BMI correlated with erythrocyte adhesiveness/aggregation (r = 0.42, p = 0.001), erythrocyte sedimentation rate (r = 0.42, p = 0.001), high-sensitive C-reactive protein (r = 0.55, p < 10(-4)), fibrinogen (r = 0.37, p = 0.004), and white blood cell count (r = 0.45, p < 10(-4)). The degree of erythrocyte adhesiveness/aggregation correlated with erythrocyte sedimentation rate (r = 0.5, p < 10(-4)), high-sensitive C-reactive protein (r = 0.56, p < 10(-4)), fibrinogen (r = 0.54, p < 10(-4)), and white blood cell count (r = 0.32, p = 0.01). DISCUSSION: Our results suggest that obesity-related erythrocyte adhesiveness/aggregation is probably mediated through increased concentrations of adhesive macromolecules in the circulation and not necessarily through hyperlipidemia or phosphatidylserine exposure on erythrocyte's membrane.