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Complications of extrahepatic echinococcosis:Fistulization of an adrenal hydatid cyst into the intestine

World Journal of Gastroenterology 2008年第9期14卷 1467-1469页

作者： Juan Francisco Ruiz-Rabelo Manuel Gomez-Alvarez Joaquin Sanchez-Rodriguez sebastian rufian pea Department of General Surgery Reina Sofia University Hospital Avda Menendez Pidal S/N Cordoba 14004 Spain

Echinococcal cysts are usually found in liver and lungs, but any other organ can potentially be involved. Extrahepatic disease due to hydatid cyst may develop in the abdominal and pelvic cavity, aside from in other less common locations, which may make both diagnosis and treatment more complex. We present a rare case of extrahepatic echinococcosis in a 70-year old patient with a 4-d history of dull abdominal pain, anemia within the transfusion range and fever. She underwent surgery for left renal hydatid cysts 30 years ago. After non operative treatment, imaging studies showed a calcified hydatid cyst in a retrogastric location communicating with a proximal jejunal loop. En-block resection of the mass together with the adrenal gland was performed including closure of the enteric fistula. Anatomic pathology confirmed the diagnosis of a calcified hydatid cyst of left adrenal origin. Surgery is the treatment of choice and most authors recommend removal of cyst and adrenal gland.

关键词： Echinococcosis Adrenal cyst Surgery

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Gastrointestinal stromal tumors:a multidisciplinary challenge

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World Journal of Gastroenterology 2018年第18期24卷 1925-1941页

作者： Juan Manuel Sanchez-Hidalgo Manuel Duran-Martinez Rafael Molero-Payan sebastian rufian-pena Alvaro Arjona-Sanchez Angela Casado-Adam Antonio Cosano-Alvarez Javier Briceno-Delgado Department of General and Digestive Surgery Reina Sofia University HospitalAvda.Menéndez Pidal s/nCordoba 14004Spain Department of Intern Medicine Reina Sofia University HospitalAvda.Menéndez Pidal s/nCordoba 14004Spain Lipids and Atherosclerosis Research Unit IMIBIC/Hospital Universitario Reina Sofía/Universidad de CórdobaCordoba 14004Spain

Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs(> 95%) are positive for the KIT protein(CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis(the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvantImatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.

关键词： Gastrointestinal stromal tumors Surgery Oncology Radiology Endoscopy Nuclear medicine Pathology Disease management Tyrosine kinase inhibitors Gastroenterology

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Strategies to reduce hepatitis C virus recurrence after liver transplantation

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World Journal of Hepatology 2013年第5期5卷 237-250页

作者： Ruben Ciria María Pleguezuelo Shirin Elizabeth Khorsandi Diego Davila Abid Suddle Hector Vilca-Melendez sebastian rufian Manuel de la Mata Javier Briceo pedro López Cillero Nigel Heaton Institute of Liver Studies King’s College HospitalLondon SE5 9RSUnited Kingdom Unit of Hepatology and Liver Transplantation University Hospital Reina Sofías/n 1400 CórdobaSpain Unit of Hepatobiliary Surgery and Liver Transplantation University Hospital Reina Sofías/n 1400 CórdobaSpain

Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not retransplanting this patients, as lower patient and graftoutcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pretransplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of posttransplant HCV recurrence and strategies to reduce its impact on our patients.

关键词： Hepatitis C virus Recurrence Liver Trans- plantation Outcomes

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