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Laparoscopic gastrojejunostomy for gastric outlet obstruction in patients with unresectable hepatopancreatobiliary cancers: A personal series and systematic review of the literature

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World Journal of Gastroenterology 2018年第18期24卷 1978-1988页

作者： Alba Manuel-Vázquez Raquel Latorre-Fragua carmen ramiro-pérez Aylhin López-Marcano Roberto De la plaza-Llamas José Manuel Ramia Department of General and Digestive Surgery University Hospital of Guadalajara

The major symptoms of advanced hepatopancreaticbiliary cancer are biliary obstruction, pain and gastric outlet obstruction(GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according pRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. Decisionmaking must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation ofthe patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.

关键词： Duodenal obstruction Gastrojejunostomy Gastroenterosmy Gastric outlet obstruction Gastric bypass Laparoscopy Laparoscopic surgery Sytematic review

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Ninety-day readmissions after inpatient cholecystectomy: A 5-year analysis

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World Journal of Gastroenterology 2017年第16期23卷 2972-2977页

作者： Alba Manuel-Vázquez Raquel Latorre-Fragua carmen ramiro-pérez Aylhin López-Marcano Farah Al-Shwely Roberto De la plaza-Llamas JoséManuel Ramia Department of General and Digestive Surgery University Hospital of Guadalajara19002 GuadalajaraSpain

AIM To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. METHODS We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomyrelated complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies. RESULTS We analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of4.99%. Sixty-four point seven nine percent occurred after elective surgery(cholelithiasis or vesicular polyps) and 35.21% after emergency surgery(acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d. CONCLUSION The use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure.

关键词： Cholecystectomy 90-d Hospital readmission Readmission rate Cholelithiasis

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Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury

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World Journal of Nephrology 2024年第2期13卷 5-15页

作者： Xabier pérez-Aizpurua ramiro Cabello Benavente Gonzalo Bueno Serrano JoséMaría Alcázar peral Blanca Gómez-Jordana Mañas Jaime Tufet i Jaumot Joaquín Ruiz de Castroviejo Blanco Felipe Osorio Ospina carmen Gonzalez-Enguita Department of Urology Hospital Universitario Fundación Jiménez DíazMadrid 28015MadridSpain

Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary *** is regarded as one of the most prevalent causes of acute kidney injury(AKI),accounting for 5%–10%of *** severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve *** aim of the present article is to review and synthesize available evidence on obstructive uropathy,providing a clinical guideline for clinicians.A literature review on obstructive uropathy in the context of AKI was performed,focusing on the least clarified aspects regarding diagnosis and *** literature searching was conducted in English and top-level evidence articles including systematic reviews,metanalyses and large series were *** obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the *** recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection.A multidisciplinary approach,including urologists,nephrologists,and other medical specialties,is best suited to correctly manage concomitant hemodynamic changes,fluid and electrolyte imbalances,and other related *** uropathy is one of the leading causes of *** of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challeng-ing.A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.

关键词： Obstructive uropathy Urinary tract obstruction Obstruction of the urinary tract Acute kidney injury Urinary diversion Renal recovery

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Effective prophylaxis with rFVIIa in young haemophiliacs with inhibitors using a schedule similar to FVIII prophylaxis in non-inhibitor patients

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Health 2013年第7期5卷 1151-1157页

作者： Maria Fernanda Lopez-Fernandez carmen Altisent Victor Jimenez-Yuste Faustino Garcia-Candel carmen Sedano Ana Cid Eva Mingot ramiro Nunez Maria Jose paloma Inmaculada Soto Manuel prieto Haematology Complejo Hospitalario Universitario A CorunaA CorunaSpain Haemophilia Unit Hospital Universitario Vall d’HebronBarcelonaSpain Haemophilia Unit Hospital UniversitarioMadridSpain Haemophilia Unit Hospital Universitario Virgen de la ArreixacaMurciaSpain Haematology Complejo Hospitalario Universitario Marques de ValdecillaSantanderSpain Congenital Coagulophaties Unit Hospital Universitario La FeValenciaSpain Haematology Hospital Universitario Carlos HayaMalagaSpain Haematology Hospital Universitario Virgen del RocíoSevillaSpain Haematology Hospital Virgen del CaminoPamplonaSpain Haematology Hospital General de AsturiasOviedoSpain Haematology Hospital General YagüeBurgosSpain

Objective: To assess the role of early prophylaxis with recombinant activated factor VII (rFVIIa) in young haemophiliacs with inhibitors and to determine whether it can reduce bleeding episodes and prevent joint damage. patients and Methods: Ten severe haemophiliacs, less of three years old, with up to four joint bleeds and inhibitors to FVIII who started early prophylaxis with rFVIIa, were included. A number of haemorrhages/year/patient and haemarthroses/ year/patient were compared before the start of prophylaxis, which include both the time before (initial period) and after inhibitor diagnosis (inhibitor period), with those during prophylaxis (prophylaxis period). Results: The mean time of inhibitor diagnosis was 15.6 months (range: 2.3-34.1). The mean time between inhibitor diagnosis and the start of prophylaxis was 7.1 months (range: 0-23.2), shorter than the time of rFVIIa prophylaxis (mean: 10.3 months;range: 4.1-32.0). Bleeding episodes for the three time periods were 45, 36 and 17, respectively, or 0.29 and 0.51 haemorrhages/year/patient in the two periods prior to prophylaxis compared to 0.17 during prophylaxis. Total haemarthroses for the three-time periods were 7, 5 and 5, respectively. The haemarthroses/year/patient in the pre-prophylaxis period were 0.032 and 0.070, compared to0.049 inthe prophylaxis period. rFVIIa schedules were either 90 μg/kg three times weekly or 90 μg/kg daily. Conclusions: Early prophylaxis with rFVIIa may be efficacious in young haemophiliacs with inhibitors, reducing joint bleeds. After the risky period of inhibitor presence, they are able to continue rFVIII prophylaxis with success assured to prevent arthropathy.

关键词： rFVIIa Haemarthroses Haemophilia Inhibitors prophylaxis

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Fecal immunochemical test accuracy in average-risk colorectal cancer screening

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World Journal of Gastroenterology 2014年第4期20卷 1038-1047页

作者： Vicent Hernandez Joaquin Cubiella M carmen Gonzalez-Mao Felipe Iglesias Concepción Rivera M Begoa Iglesias Lucía Cid Ines Castro Luisa de Castro pablo Vega Jose Antonio Hermo ramiro Macenlle Alfonso Martínez-Turnes David Martínez-Ares pamela Estevez Estela Cid M carmen Vidal Angeles López-Martínez Elisabeth Hijona Marta Herreros-Villanueva Luis Bujanda Jose Ignacio Rodriguez-prada the COLONpREV study investigators Department of Gastroenterology Complexo Hospitalario Universitario de Vigo Department of Gastroenterology Complexo Hospitalario Universitario de Ourense Department of Clinical Analysis Complexo Hospitalario Universitario de Vigo Department of pathology Complexo Hospitalario Universitario de Vigo Department of Gastroenterology Donostia Hospital Biodonostia Institute University of the Basque Country UPV/EHU

AIM: To assess the fecal immunochemical test (FIT) accuracy for colorectal cancer (CRC) and advanced neoplasia (AN) detection in CRC screening.

关键词： Colorectal neoplasms Early detection of cancer Sensitivity and specificity Adenoma Occult blood Cost-benefit analysis

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Added after Anoxia-Reoxigenation Stress, Genistein Rescues from Death the Rat Embryo Cortical Neurons

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Neuroscience & Medicine 2010年第2期1卷 50-59页

作者： Arce carmen Arteaga José Luis Sánchez-mendoza Eduardo Oset Gasque Ma Jesús González Ma pilar Centro de Investigaciones Biológicas CSIC Ramiro de Maeztu Madrid Spain Department of Biochemistry and Molecular Biology Faculty of Pharmacy Universidad Complutense Madrid Spain

Estrogens and phytoestrogens have neuroprotective effect against neuronal damage induced by cerebral ischemia /reperfusion (I/R) injury. In preceding studies, the phytoestrogen effects have been assessed by administration previous to the ischemic period, conditions which are unusual to apply to the treatment of human stroke. Here we present a study on neuroprotection afforded by genistein on rat embryo cortical neurons subjected to oxygen and glucose deprivation (OGD) followed by re-oxigenation, when added after the stress stimulus. At 1 and 2 h of OGD times and after 24 h of reperfusion, cell viability, necrotic, apoptotic and autophagic cell death and different parameters related to oxidative stress and mitochondrial dysfunction were measured in the absence and presence of 1 μM genisteine. We found an in-creasing loss of neuronal viability after 1-5 h of OGD which was only reversed in part by 24 h of reperfusion. These changes were preceded by increases in ROS generation, caspase-3 activation, LDH release and increase in LC3B lipi-dation, indicative of autophagia. Treatment with 1 μM genistein during the 24 h reperfusion significantly attenuated neuronal necrosis and autophagia induced by 1 and 2 h of OGD exposure. Genistein also decreased ROS generation and lipid-peroxidation induced by 2 h of OGD. These results suggest an important neuroprotective effect of genistein against transient post-ischemic-like

关键词： Cortical Neurons Oxygen-glucose Deprivation Brain Ischemia Neuronal Death Necrosis Apoptosis Autophagy

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