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Minimally Invasive Surgery for Necrotizing Pancreatitis: A Case Report

Surgical Science 2024年第9期15卷 514-521页

作者： Néstor Veriel Méndez Huerta Luis Fernando Zorrilla Núñez Noelia Obregón Gaxiola César Jair Treviño Arizmendi gerardo Iván Muñoz Morales Marco Alejandro Arizmendi Villarreal Pamela Denisse Valdez Navarro Marco Antonio Hernández Guedea gerardo Enrique Muñoz Maldonado Service of General Surgery Hospital Universitario Dr. Jos Eleuterio Gonzlez Universidad Autnoma de Nuevo Len Monterrey Mxico

Introduction: Necrotizing pancreatitis management is complex and varies significantly among clinicians. Minimally invasive approaches like transgastric necrosectomy via laparoscopy are emerging as effective treatment options. This case report underscores the technique’s efficacy, clinical outcomes, and role in reducing complications. Clinical Observation: A 59-year-old male with a history of smoking and alcoholism presented with severe abdominal pain, nausea, and vomiting. Over the following weeks, he developed symptoms including asthenia, weight loss, and melena. Diagnostic workup revealed severe anemia and Balthazar E necrotizing pancreatitis, with significant intra-abdominal fluid collections and signs of infection. After initial conservative management, the patient underwent transgastric necrosectomy via laparoscopy due to deteriorating clinical status. The procedure involved removing necrotic tissue and performing a cystogastroanastomosis and jejunostomy. Postoperative care included fasting, parenteral nutrition, broad-spectrum antibiotics, and enzymatic replacement. The patient recovered well, with reduced necrotic tissue on follow-up imaging, and was discharged twelve days post-surgery [1]. Conclusion: Transgastric necrosectomy by laparoscopy is a valuable first-line surgical option for patients with symptomatic necrotizing pancreatitis, particularly in cases without prior interventions. This minimally invasive technique helps reduce major complications and mortality, offering a less invasive alternative to traditional open necrosectomy. The multidisciplinary approach and careful postoperative management were crucial to the patient’s favorable outcome. The case highlights the potential of transgastric necrosectomy as an effective treatment strategy in managing complex pancreatitis cases, including those with associated duodenal perforation [2].

关键词： Necrotizing Transgastric Pancreatic Necrosectomy Pancreatitis Case Report

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A Systematic Review of Cannabidiol Effects in Coronary Syndromes: Challenges to Clinical Translation

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Journal of Biosciences and Medicines 2024年第4期12卷 246-263页

作者： Mario E. Zuñiga-Ayala Alejandra Meaney-Martínez Alejandro Alcocer-Chauvet Vidal Gonzalez-Coronado Nestor Rubio-Infante gerardo Garcia-Rivas Department of Cardiology Instituto de Seguridad Social and Trabajadores del Estado (ISSSTE) Hospital Regional Primero de Octubre Mexico City Mexico Department of Interventional Cardiology Instituto de Seguridad Social y Trabajadores del Estado (ISSSTE) Hospital Regional Primero de Octubre Mexico City Mexico Instituto Tecnó logico de Monerrey Escuela de Medicina and Ciencias de la Salud C&#225tedra de Cardiolog&#237a and Medicina Vascular Monterrey Mexico

Background: Myocardial ischemia in addition to other several cardiac syndromes represent a pathological proinflammatory state alongside a complex cellular microenvironment that can be modified by using cannabinoids. Cannabidiol (CBD), a non-psychoactive compound of cannabis has been recently proposed as an immudomodulatory and cardioprotective drug. Objectives: In this systematic review we sought to clarify and summarize the clinical and preclinical evidence of potential benefit of the use of CBD in coronary syndromes. Methods: We conducted a systematic search and review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Review of Animal Data from Experimental Studies (CAMARADES) guidelines, in the electronic database from PubMed, Web of Science and Scopus up to April 2022 using predefined search terms. Pre-specified exclusion and inclusion criteria were considered, finally 11 articles were chosen to be included for this peer review. Results: Currently there are no good-quality clinical trials with the use of CBD in acute or chronic coronary syndromes. A total of 11 preclinical studies where prescreened and 5 demonstrated reproducible positive cardiovascular outcomes on in-vivo models treated with CBD. Mechanisms of CBD cardioprotection observed: 1) reduction in oxidative stress and inflammation, 2) activation of adenosine receptors and 3) increased expression of angiotensin type 2-receptor. Experimental models included ischemia/reperfusion injury, myocardial infarction, arrhythmias, and metabolic syndrome-like conditions. Conclusion: No clinical recommendation can be issued with the current evidence, on the use of CBD in acute and chronic coronary syndromes. Based on preclinical evidence, we considered there is enough evidence to propose the development of well-designed clinical trials that include CBD in the management of coronary syndromes.

关键词： Cannabis Cannabidiol Acute Coronary Syndromes Myocardial Infarction Myocardial Ischemia and Oxidative Stress

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Role of chemotherapy and novel biological agents in the treatment of elderly patients with colorectal cancer

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World Journal of Gastroenterology 2008年第12期14卷 1812-1822页

作者： gerardo Rosati Domenico Bilancia Medical Oncology Unit S. Carlo Hospital Potenza 85100 Italy

Patients older than 65 years are the fastest growing segment of the cancer population. It is estimated that within 20 years over 75% of cases and 85% of deaths from colorectal cancer (CRC) will be in this setting. Concerns about cancer treatment in the elderly relate to comorbidities, which increase proportionally with age, physiological changes associated with aging which may influence drug metabolism and toxicity, and diminishing life expectancy, which particularly impacts decisions surrounding the benefits of adjuvant therapies. Over the last 10 years, significant improvements in the treatment of advanced CRC with combination therapy have been made. The randomized trials which have defined these improvements did not exclude elderly patients. However, the median age of patients in these trials has generally been approximately 60 years. Thus, it appears that some degree of selection is involved with younger and presumably fitter patients being the subjects in most of the pivotal trials. The availability of new molecularly targeted agents and newly improved existing agents has expanded the range of treatment options available. This variety gives greater flexibility in dealing with different subsets of patients, such as the elderly. However, some fit elderly patients seem to tolerate combination therapy reasonably well, while studies on unfit elderly subjects are needed.

关键词： Bevacizumab Chemotherapy Cetuximab Colorectal cancer Elderly patients

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Diet,H pylori infection and gastric cancer:Evidence and controversies

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World Journal of Gastroenterology 2007年第21期13卷 2901-2912页

作者： Alba Rocco gerardo Nardone Department of Clinical and Experimental Medicine Gastroenterology UnitUniversity "Federico Ⅱ"Naples Italy

Despite decreasing incidence and mortality rates, gastric cancer (GC) still remains the fourth most common cancer and the second most common cause of cancer-related deaths worldwide. Due to the limited treatment options, at present, prevention is likely to be the only effective means of controlling this disease. The success of a prevention strategy depends upon the understanding of etiological and pathogenic mechanisms underlying gastric carcinogenesis. The etiology of GC is multi-factorial, however, in the recent years, mounting evidence suggests that environmental factors play a key role. The most important environmental factors implicated in the pathogenesis of GC are diet and H pylori infection. Thus, modifications in lifestyle and dietary habit associated with eradication of H pylori infection could hypothetically represent the most promising potential targets for GC prevention. In this review we will address the evidence and the controversies on the role of these agents in noncardia GC by focusing on retrospective and prospective observational studies and interventional trials.

关键词： Gastric cancer Hpylori Diet Observational studies Interventional dietary trials

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Endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction in Mexico

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World Journal of Surgical Procedures 2024年第3期14卷 15-20页

作者： Massiel Madelin Rosario-Morel Rodrigo Soto-Solis Katia Picazo-Ferrera Miriam Idalia Torres-Ruiz JoséAlberto Estradas-Trujillo Mario Alberto Gallardo-Ramírez gerardo Akram Darwich-del Moral Luis Ariel Waller-González Department of Endoscopy Centro Médico Nacional“20 de Noviembre”ISSSTEMexico City 03229Mexico Department of Gastroenterology HospitalÁngeles PedregalMexico City 10700Mexico Department of Endoscopy Centro Médico ABCMexico City 01120Mexico Department of Endoscopy Hospital General de México“Dr.Eduardo Liceaga”Mexico City 06720Mexico

BACKGROUND Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has recently emerged as an alternative treatment for gastric outlet obstruction(GOO)in selected *** To report the initial experience of EUS-GE in patients with *** This study was a retrospective,observational,multicenter study in which the data from 10 patients who underwent EUS-GE due to GOO between September 2021 and May 2023 were *** analyzed technical success,clinical success,adverse events,and *** success was defined as adequate positioning and deployment of the *** success was defined as the patient’s ability to tolerate oral intake without vomiting 7 d after the *** adverse events were *** Eleven procedures in 10 patients with GOO were *** mean age of the patients was 67.5 years(range:56-77 years).Malignant GOO was present in 9 *** success was achieved in 9/11 procedures(82%).Among them,clinical success was achieved in 9 patients(100%).Adverse events occurred in 1 patient(9%).The median survival was 3 months(n=7;range:1-8 months).CONCLUSION EUS-GE is a feasible therapeutic option in the treatment of GOO.

关键词： Endoscopic ultrasound-guided gastroenterostomy Gastric outlet obstruction Lumen apposing metal stent Interventional endoscopic ultrasound Gastrojejunostomy Duodenal stenting

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Intensive or not surveillance of patients with colorectal cancer after curative resection

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World Journal of Gastroenterology 2010年第12期16卷 1427-1429页

作者： gerardo Rosati Medical Oncology Unit S.Carlo Hospital

It is common practice to follow patients with colorectal cancer for some years after resection and/or adjuvant *** are lacking about how often patients should be seen,what tests should be performed,and what surveillance strategy has a signifi cant impact on patient *** randomized trials have addressed this issue,but none had sufficient statistical *** published meta-analyses have established that overall survival is significantly improved for patients in the more intensive programs of *** improvement amounts to a risk difference of 7%(95% CI:3%-12%,P=0.002) in 5-year *** should be partly attributable to more frequent reoperation for cure of asymptomatic recurrence,or more intense follow-up,as well other factors,such increased psychosocial support and well-being,diet and lifestyle optimization,and/or improved treatment of coincidental diseases.A large-scale multicenter European study [Gruppo Italiano di Lavoro per la Diagnosi Anticipata(GILDA)] is underway to answer the question of what constitutes optimal surveillance for patients after primary therapy,based on an adequately powered study.

关键词： Colorectal cancer Follow-up Meta-analysis Recurrence Salvage surgery

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Combined Oxidative Phosphorylation Deficiency-20-Exome as a Diagnostic Implement

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Journal of Biosciences and Medicines 2024年第6期12卷 7-12页

作者： Paulo Roberto Matos-Neto Lucas Antonissen Lima Verde Airton Ferreira da Ponte-Filho Luís Eduardo Oliveira Matos Amandha Espavier Trés Paulo Roberto Lacerda Leal gerardo Cristino-Filho Regina Coeli de Carvalho Porto Carneiro Faculty of Medicine Federal University of Cear Sobral Cear Brazil Department of Neurosurgery Federal University of Cear Sobral Cear Brazil Department of Neuropediatrics Federal University of Cear Sobral Cear Brazil

Mitochondrial disorders are phenotypically varied, with serious clinical repercussions. Among them, there is the deficiency of combined oxidative phosphorylation of type 20, which occurs due to a defect in the VARS2 gene. This article presents a case of a 2-year-old female with progressive myoclonic epilepsy and psychomotor regression, with refractoriness to multiple anticonvulsants. The diagnosis was only made after the examination was carried out. Therefore, this article highlights the aspects of this rare disease and the importance of the exome for the diagnosis of rare conditions.

关键词： Oxidative Phosphorylation Epilepsy Exome Mitochondrial Defect VARS2

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Pathogenetic Consequences of Cytomegalovirus-Host Co-evolution

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Virologica Sinica 2008年第6期23卷 438-448页

作者： gerardo Abenes Division of Infectious Diseases School of Public HealthUniversity of California

Co-evolution has been shown to result in an adaptive reciprocal modification in the respective behaviors of interacting populations over time. In the case of host-parasite co-evolution,the adaptive behavior is most evident from the reciprocal change in fitness of host and parasite-manifested in terms of pathogen survival versus host resistance. Cytomegaloviruses and their hosts represent a pairing of populations that has co-evolved over hundreds of years. This review explores the pathogenetic consequences emerging from the behavioral changes caused by co-evolutionary forces on the virus and its host.

关键词： Cytomegalovirus Co-evolution Pathogenesis

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Cholecystoenteric fistula with and without gallstone ileus: A case series

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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 36-40页

作者： Mauricio Gonzalez-Urquijo Mario Rodarte-Shade gerardo Lozano-Balderas gerardo Gil-Galind Tecnologico de Monterrey Escuela de MedicinaCiencias de la SaludDr.Ignacio Morones Prieto O 3000Monterrey 64710México Department of Surgery Hospital Metropolitano“Dr.Bernardo Sepúlveda”Secretaria de Salud de Nuevo LeónAdolfo López Mateos No.4600San Nicolás de los Garza 66400México

Background: A cholecystoenteric stula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ileus, along with their surgical outcomes. Methods: From 2015 to 2018, 3245 consecutive patients underwent cholecystectomy for gallbladder disease at our institution, of which 15 were diagnosed with a CEF. All electronic medical records were retrospectively reviewed. Results: Fifteen patients presented with CEF. Ten patients presented cholecystoduodenal stula, four pa- tients cholecystocolonic, and one patient cholecystogastric counterparts. Twelve patients were female. The median patient age was 61 years (range 33 86 years). Five patients presented with gallstone ileus treated by laparotomy and enterolithotomy. In ten patients, a laparoscopic approach was attempted, but conversion to open surgery was necessary for eight of them. The median operative time was 140 min (range 60 240 min), and the median operative blood loss was 50 mL (range 10600mL). The procedure-related morbidity and mortality rates were 13.3% and 6.7%, respectively. Conclusions: There is no consensus on the best treatment modality for a CEF, as the treatment outcome is mostly dependent on the surgeon’s expertise and the patient’s condition. Not all CEFs are accompanied by gallstone ileus. For such case, the main purpose is to resolve the intestinal obstruction and, unless necessary, avoidance of the gallbladder area.

关键词： Cholecystoenteric stula Gallbladder disease Biliary-enteric stula Gallstone ileus Intestinal obstruction

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Analysis and Validation for an Inverter-side Current Controller in LCL Grid-connected Power Systems

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Journal of Modern Power Systems and Clean Energy 2020年第2期8卷 387-398页

作者： Jose MSosa Panfilo R.Martinez-Rodriguez gerardo Escobar gerardo Vazquez Andres A.Valdez-Fernandez Juan F.Martinez-Garcia the Tecnologico Nacional de Mexico/ITS de Irapuato(TecNM/ITESI) IrapuatoGTO 36821Mexico the School of Sciences Autonomous University of San Luis Potosi(UASLP)San Luis PotosiSLP 78290Mexico Tecnologico de Monterrey N.L.64849Mexico

Transformerless grid-connected inverters offer greater efficiencies when transferring power from renewable energy sources to the electrical *** the grid-inverter connection is done with an LCL filter,high attenuation of switching harmonics is achieved while preserving a small-size output ***,damping must be included in the controller to assure closed-loop *** paper proposes a reference computation methodology for the inverter-side current feedback in a photovoltaic(PV)generation system connected to the grid through an LCL *** analysis of the closed-loop system stability and of the steady-state performance are presented as well as experimental validation of the closed-loop *** feedback controller includes active damping and relies on a resonant control structure which improves the ability of dealing with grid harmonic *** controller uses a reduced set of measurements,which requires the inverter-side current and grid voltage only,and assures a power factor close to unity.

关键词： LCL filter transformerless inverter grid connection inverter-side current feedback

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