Carcinoid Heart Disease

Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Assessment of Response to Treatment and Follow-Up in Gastroenteropancreatic Neuroendocrine Neoplasms

Well-established criteria for evaluating the response to treatment and the appropriate followup of individual patients are critical in clinical oncology. The current evidence-based data on these issues in terms of the management of gastroenteropancreatic (GEP) neuroendocrine neoplasms (NEN) are unfortunately limited.

This document by the Italian Association of Clinical Endocrinologists (AME) on the criteria for the follow-up of GEP-NEN patients is aimed at providing comprehensive recommendations for everyday clinical practice based on both the best available evidence and the combined opinion of an interdisciplinary panel of experts.

The initial risk stratification of patients with NENs should be performed according to the grading, staging and functional status of the neoplasm and the presence of an inherited syndrome. The evaluation of response to the initial treatment, and to the subsequent therapies for disease progression or recurrence, should be based on a cost-effective, risk-effective and timely use of the appropriate diagnostic resources.

A multidisciplinary evaluation of the response to the treatment is strongly recommended and, at every step in the follow-up, it is mandatory to assess the disease state and the patient performance status, comorbidities, and recent clinical evolution.

Local expertise, available technical resources and the patient preferences should always be evaluated while planning the individual clinical management of GEP-NENs.

Therapeutic Challenges in Neuroendocrine Tumors

Neuroendocrine tumors (NETs) are a diverse set of tumors, being genetically varied. NETs can be presented with a distinct clinical picture, due to the production of various hormones, or being silent. Based on community health clinical statistics, the frequency numbers and reported occurrence of NETs are increasing. Although the therapeutic options for NETs have expanded in recent years, clinical diagnosis is possible only when metastases are present, requiring chronic complicated medical management. A positive development is that the recent evolution of molecularly-targeted therapy in oncology promotes the evolution of innovative tools for the management of these tumors. A diverse assortment of medical specialists is needed to improve outcomes and orchestrate the therapeutic care plan for NET patients.

An Exceptional Case of Atrial Fibrillation Arrhythmia Induced by Etoposide

Background: Arrhythmia induced by etoposide is exceedingly rare. There are only a very few individual case histories of arrhythmias during etoposide infusion, including atrial fibrillation. Objective: Through this uncommon case, we propose to study the pathophysiology, the diagnosis and the management of this entity.

Case Report: We report a case of a 57-year-old man, without cardiac history, followed for endocrine tumor of the pancreas with liver metastases who had presented atrial fibrillation (AF) after etoposide infusion.

Conclusion: It is important to consider cardiac monitoring during etoposide infusion in patients with known cardiac disease or at high risk of cardiac complications.

Value of Real Time Three Dimensional Transesophageal Echocardiography in General Cardiology Practice

Echocardiography plays a central role in modern practice of cardiology. The diagnostic capabilities of this technique have evolved tremendously over the last three decades. From an anatomic and quantitative standpoint, the recent introduction of real time three dimensional (3D) imaging in association with transesophageal echocardiography (TEE) has greatly facilitated identification of cardiac pathology, decision making regarding the best therapeutic approach, and communication of the findings with interventionists and cardiothoracic surgeons. It has also offered a means of properly monitoring percutaneous interventions and results of surgical repair. This review provides a summary of a recent patent, current clinical application, and future potentials of real time 3D TEE in the general practice of adult cardiovascular disease.

Neuronal Regulation of Aortic Valve Cusps

Heart valves have long been considered exclusively passive structures that open and close in response to changes in transvalvular pressure during the cardiac cycle. Although this is partly true, recent evidence suggests that valves are far more sophisticated structures. Microscopic examination of heart valves reveals a complex network of endothelial cells, interstitial cells, an extracellular matrix and a rich network of intrinsic nerves. The distribution of these nerve networks varies between the four valves, but is remarkably conserved between species. The present review will focus mainly on aortic valve innervation for several reasons: it is most commonly involved in disease processes, it lies in a unique hemodynamic environment and is exposed to extreme mechanical forces. These nerves are likely to play a significant role in the modulation of aortic valve structure and function and its adaptation to different hemodynamic and humoral conditions. The objectives of this review are first to describe the anatomy of aortic valve innervation, then detail the functional significance of innervation to the valve and finally make the case for the clinical relevance of understanding the neural control of aortic valves and its potential pharmacologic implications.