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Ambispective comparative study of two surgical strategies for liver hydatidosis

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World Journal of Gastroenterology 2012年第6期18卷 546-550页

作者： jose m ramia Francisco Ruiz-Gomez Roberto De la Plaza Pilar Veguillas jose Quiones Jorge García-Parreo Department of Surgery Hepato-Bilio-Pancreatic Surgery UnitGuadalajara University HospitalGuadalajara 19002Spain

AIm:To investigate the morbidity,mortality,recurrence and technical aspects of two distinct surgical strategies that were implemented in successive ***:Ninty-two patients with 113 cysts underwent surgical *** study was divided into 2 *** from first period(P1) were compiled *** surgical strategy was conservative *** second period(P2) included a prospective study conducted according to a protocol following the criterion that radical procedures should be performed whenever it is technically ***:Patients of both periods showed no statistically significant differences in age,gender,cyst location or *** the P2 group,patients exhibited more preoperative jaundice,and cyst size was smaller(P morbidity and in-hospital stay(P minishes morbidity and in-hospital *** surgery must be employed only in selected cases.

关键词： Hydatid disease Surgery morbidity Liver

Liver metastasis of endometrial stromal sarcoma

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World Journal of Hepatology 2012年第12期4卷 415-418页

作者： jose m ramia Roberto De la Plaza Ines Garcia Cristian Perna Pilar Veguillas Jorge García-Parreo Department of Surgery Hepatopancreatobiliary Surgical UnitHospital Universitario de GuadalajaraGuadalajara28020 MadridSpain Department of Oncology Hospital Universitario de GuadalajaraGuadalajara28020 MadridSpain Department of Pathology Hospital Universitario de GuadalajaraGuadalajara28020 MadridSpain

Resection of liver metastases from gynaecological tumours is *** stromal sarcomas(ESS) are low incidence gynecological tumours which can originate in previous sites of endometriosis or following metaplasia of the pelvic peritoneal wall,and which are exceptionally associated with liver *** present a 68-year-old woman with a ESS and metachronic liver metastasis treated by liver *** is very little literature on clinical management about liver metastasis from ESS,but extrapolating the data obtained with liver metastasis from sarcomas and uterine tumours,we should recommend resection as this is considered a resectable extrauterine *** cases with more sites of extrauterine disease,liver resection should also be performed if the other sites are resectable.

关键词： Sarcoma Stromal Endometrial Liver metastasis Review

Percutaneous drainage as a first therapeutic step prior to surgery in liver hydatid cyst abscess:Is it worth it?

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World Journal of Hepatology 2017年第2期9卷 114-118页

作者： Aylhin J Lopez-marcano jose m ramia Vladimir Arteaga Roberto De la Plaza Jhonny D Gonzales Anibal medina Hepato-Pancreato-Biliary Surgical Unit Department of SurgeryHospital Universitario de Guadalajara19002 GuadalajaraSpain

AImTo delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity. mETHODSUsing this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm. RESULTSAll patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. Surgery was performed two weeks after admission, once the patient’s condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded. CONCLUSIONLHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient’s general condition. This enables treating patients in greater safety and also reduces complications.

关键词： Hydatidosis Review Surgery Abscess Liver

Liver metastases from Gynecological Cancers: Time to Resection?

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Surgical Science 2012年第3期3卷 120-125页

作者： jose m.ramia Roberto De La Plaza jose Quinones Pilar Veguillas Farah Adel Jorge Garcia-Parreno Unidad de Cirugia Hepatobiliopancreatica Servicio de Cirugia General y Aparato DigestivoHospital Universitario de GuadalajaraGuadalajaraSpain

Aim: To perform an update of liver resection as treatment of liver metastases of gynecological cancers, as well as an update on these metastases. Bibliographical search: Pubmed Search 1990-2011 in English language. Authors reviewed only relevant articles. Results: No more than 20 relevant articles have been published on this topic, including case reports. We performed a classical review of the information published in the literature. Conclusions: Liver metastases from Gynecological cancers, not peritoneal implants in the liver, usually appear in patients with disseminated disease, so it is uncommon to perform a liver resection. In some patients with limited extrahepatic disease or only liver disease, liver resection is a safe alternative and improves the oncological results. We try to emphasize which patients may benefit from liver resection and the importance of tailoring medical decisions.

关键词： Liver metastasis Gynecology Ovary Cancer Review

How to select a journal for your research

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World Journal of Gastroenterology 2023年第21期29卷 3379-3384页

作者： Josém ramia Department of Surgery Hospital General Universitario Dr.BalmisAlicante 03010Spain

Publication in a peer-reviewed journal is the goal of any research *** of the most important(and possibly the least understood)aspects of the publication process is the choice of a suitable journal that is likely to a... 详细信息

关键词： Research Journal Altmetrics Publication

Tricks and tips in pancreatoduodenectomy

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World Journal of Gastrointestinal Oncology 2014年第9期6卷 344-350页

作者： Anna Pallisera Rafael morales jose manuel ramia Department of Surgery Hospital Son Llatzer HPB Unit Department of SurgeryHospital Universitario de Guadalajara

Pancreaticoduodenectomy(PD) is the standard surgical treatment for tumors of the pancreatic head,proximal bile duct,duodenum and ampulla,and represents the only hope of cure in cases of *** its initial description in 1935 by Whipple et al,this complex surgical technique has evolved and undergone several *** review three key issues in PD:(1) the initial approach to the superior mesenteric artery,known as the artery-first approach;(2) arterial complications caused by anatomic variants of the hepatic artery or celiac artery stenosis;and(3) the extent of lymphadenectomy.

关键词： Pancreas Pancreaticoduodenectomy Artery-first Surgery Lymphadenectomy Celiac axis Hepatic artery

Hilar cholangiocarcinoma

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World Journal of Gastrointestinal Oncology 2013年第7期5卷 113-114页

作者： José m ramia Department of Surgery Hospital Universitario de Guadalajara19002 GuadalajaraSpain

Hilar cholangiocarcinoma(HC) is a rare *** accounts for 2/3 of the tumors of the biliary ***,prognosis is very *** is the only therapy that offers the possibility of cure but is technically very *** recent improvements in the therapeutic strategies applied by multidisciplinary teams,survival rates in the different series currently range from 25% to 45%.A group of experts devoted to HC(pathologists,gastroenterologists,radiologists,surgeons and oncologists) have reviewed and updated every open question in HC in a special issue.

关键词： Cholangiocarcinoma Hilar Perihilar Klatskin Surgery Cancer Review

Cost of postoperative complications:How to avoid calculation errors

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World Journal of Gastroenterology 2020年第21期26卷 2682-2690页

作者： Roberto De la Plaza Llamas Josém ramia Department of General and Digestive Surgery Hospital Universitario de GuadalajaraGuadalajara 19002Spain

Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it *** studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and *** payment system in place often rewards the volume of services provided rather than the quality of patients’clinical *** a thorough registration of PC,the economic costs involved cannot be *** accurate,reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results,and bring down the economic *** article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index,discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established,and makes various *** availability of accurate and impartially audited data on PC will help reduce their incidence and bring down ***,the health authorities,and society as a whole are sure to benefit.

关键词： morbidity Postoperative complications Costs and cost analysis Economic evaluation Healthcare costs Opportunity cost Clavien-Dindo classification Comprehensive complication index

Postoperative complications in gastrointestinal surgery: A “hidden” basic quality indicator

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World Journal of Gastroenterology 2019年第23期25卷 2833-2838页

作者： Roberto De la Plaza Llamas Josém ramia Department of General and Digestive Surgery Hospital Universitario de GuadalajaraGuadalajara 19002Spain

Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessment of their impact could help to evaluate the real morbidity associated with different surgical interventions, establish measures for improvement, increase efficiency and identify benchmarking services. The Clavien-Dindo Classification is the most widely used system worldwide for assessing postoperative ***, the postoperative period is summarized by the most serious complication without taking into account others of lesser magnitude. Recently,two new scoring systems have emerged, the Comprehensive Complication Index and the Complication Severity Score, which include all postoperative complications and quantify them from 0(no complications) to 100(patient’s death), These allow the comparison of results. It is important to train surgical staff to report and classify complications and to record 90-d morbidity rates in all patients. Comparisons with other services must take into account patient comorbidities and the complexity of the particular surgical procedure. To avoid subjectivity and bias, external audits are necessary. In addition, ensuring transparency in the reporting of the results is an urgent obligation.

关键词： morbidity Postoperative complications Health policy Comprehensive Complication Index Clavien-Dindo Classification Complication Severity Score