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World Journal of Gastroenterology 2008年第27期14卷 4407-4409页

作者： Sergio Zepeda-Gómez Jesús Camacho Edgar Oviedo-Cárdenas Carmen Lome-Maldonado department of Gastrointestinal Endoscopy Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" department of Pathology Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"

Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of the non-Hodgkin’s lymphoma (NHL) accounting for about 40% of all NHLs. This is a case report about the endoscopic appearance of a DLBCL with infiltration to the stomach in a 39-year-old female. She had a 6-mo history of lumbar and left upper quadrant pain with intermittent episodes of melena. A computer tomograghy (CT) scan showed mural thickening of the gastric antrum. Endoscopic examination revealed multiple gastric ulcers. definite diagnosis could be made by endoscopic biopsies and the patient had a good response to chemotherapy. This response correlated well with a further endoscopic follow-up. A follow-up endoscopic examination could be considered to evaluate a good response to chemotherapy in DLBCL patients with secondary gastric dissemination.

关键词： Diffuse large B-cell lymphoma Non-Hodgkin's lymphoma Gastric infiltration

New insights into the pathophysiology of achalasia and implications for future treatment

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World Journal of Gastroenterology 2016年第35期22卷 7892-7907页

作者： Janette Furuzawa-Carballeda Samuel Torres-Landa Miguel ángel Valdovinos Enrique Coss-Adame Luis A Martín del Campo Gonzalo Torres-Villalobos department of Immunology and Rheumatology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán department of Experimental Surgery Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Idiopathic achalasia is an archetype esophageal motor disorder, causing significant impairment of eating ability and reducing quality of life. The pathophysiological underpinnings of this condition are loss of esophageal peristalsis and insufficient relaxation of the lower esophageal sphincter(LES). The clinical manifestations include dysphagia for both solids and liquids, regurgitation of esophageal contents, retrosternal chest pain, cough, aspiration, weight loss and heartburn. Even though idiopathic achalasia was first described more than 300 years ago, researchers are only now beginning to unravel its complex etiology and molecular pathology. The most recent findings indicate an autoimmune component, as suggested by the presence of circulating anti-myenteric plexus autoantibodies, and a genetic predisposition, as suggested by observed correlations with other well-defined genetic syndromes such as Allgrove syndrome and multiple endocrine neoplasia type 2 B syndrome. Viral agents(herpes, varicella zoster) have also been proposed as causative and promoting factors. Unfortunately, the therapeutic approaches available today do not resolve the causes of the disease, and only target the consequential changes to the involved tissues, such as destruction of the LES, rather than restoring or modifying the underlying pathology. New therapies should aim to stop the disease at early stages, thereby preventing the consequential changes from developing and inhibiting permanent damage. This review focuses on the known characteristics of idiopathic achalasia that will help promote understanding its pathogenesis and improve therapeutic management to positively impact the patient's quality of life.

关键词： Achalasia Treatment Autoimmune disease Pathophysiology

Prevalence of metabolic syndrome, obesity and diabetes type 2 in cryptogenic cirrhosis

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World Journal of Gastroenterology 2008年第30期14卷 4771-4775页

作者： Felix I Tellez-Avila Francisco Sanchez-Avila Mauricio García-Saenz-de-Sicilia Norberto C Chavez-Tapia Ada M Franco-Guzman Gustavo Lopez-Arce Eduardo Cerda-Contreras Misael Uribe department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

AIM: To evaluate the prevalence of metabolic syndrome (MS), obesity and type 2 diabetes mellitus (T2DM) in a group of Mexican Mestizo patients with cryptogenic cirrhosis (CC) and to compare this group with patients with cirrhosis secondary to other causes (disease controls). METHODS: Patients with CC, diagnosed between January, 1990 and April, 2005, were included in a retrospective study. Patients with cirrhosis caused by chronic hepatitis C, alcohol abuse or autoimmune hepatitis (AIH) served as disease controls. RESULTS: A total of 134 patients with CC were analyzed. Disease controls consisted of 81 patients with chronic hepatitis C, 33 with alcohol abuse and 20 with AIH. The median age of patients with CC was 57 years (range, 16-87); 83 (61.9%) patients were female; 53 (39.6%) were Child A, 65 (48.5%) Child B, and 16 (11.9%) were Child C cirrhosis. The prevalence of MS (29.1% vs 6%; P der-recognized role in CC.

关键词： Cryptogenic chronic hepatitis Metabolic syndrome Obesity Diabetes mellitus

Clinical characteristics and surgical treatment of schwannomas of the esophagus and stomach: A case series and systematic review

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World Journal of Gastrointestinal Oncology 2019年第9期11卷 750-760页

作者： Jesús Morales-Maza Francisco Ulises Pastor-Sifuentes Germán E Sánchez-Morales Emilio Sanchez-Garcia Ramos Oscar Santes Uriel Clemente-Gutiérrez Adriana Simoneta Pimienta-Ibarra Heriberto Medina-Franco department of Surgery Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

BACKGROUND Gastrointestinal schwannomas are slow-growing benign mesenchymal neoplasms that originate from Schwann cells of the nerve sheath of Auerbach′s plexus or less frequently from Meissner′s *** main differential diagnosis of gastric schwannomas are the gastrointestinal stromal tumors(GISTs),which are classified by their *** treatment of choice for gastric schwannomas is surgery where laparoscopy plays an important *** resection,subtotal or total gastrectomy can be *** its counterpart,esophageal schwannomas are benign tumors of the esophagus that are very uncommon since they comprise less than 2%of all esophageal *** main differential diagnosis is the leiomyoma which corresponds to the most common benign esophageal tumor,followed by *** treatment consists on tumoral enucleation or *** To review the available literature about gastrointestinal schwannomas;especially lesions from de stomach and esophagus,including diagnosis,treatment,and follow up,as well as,reporting our institutional *** A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes *** following databases were used for reviewing process:Pub Med,Ovid,MEDLINE,and *** English language manuscripts were *** gastrointestinal schwannomas specifically located in the esophagus and stomach were *** that did not report long-term follow-up were *** Gastric localization showed a higher prevalence in both,the literature review and our institution:94.95%(n=317)and 83%(n=5)*** a follow-up with disease-free survival greater than 36 mo in most cases:62.01%(n=80)vs66.66%(n=4).In both groups,the median size was>4.1 *** treatment is curative in most cases CONCLUSION Schwannoma must be taken into account in the differential diagnosis of gastrointestinal mesenchymal *** has a good prognosis,and most are benig

关键词： Schwannoma Esophagus Stomach Surgery Systematic review

Clinical heterogeneity in autoimmune acute liver failure

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World Journal of Gastroenterology 2007年第12期13卷 1824-1827页

作者： Norberto C Chavez-Tapia Julio Martinez-Salgado Julio Granados Misael Uribe Felix I Tellez-Avila department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City MexicoJulio Granados Department of Immunology and Rheumatology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico department of Immunology and Rheumatology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico

AIM: To describe the outcome and prognosis in a cohort of patients with acute liver failure due to autoimmune hepatitis without liver transplantation. METHODS: A retrospective trial was conducted in 11 patients with acute liver failure due to autoimmune hepatitis who attended the Instituto Nacional de Ciencias Médicas y nutrición Salvador Zubiran. demographic, biochemical and severity indexes, and treatment and outcome were assessed. RESULTS: Among the 11 patients, with a median age of 31 years, 72% had inflammatory response syndrome, and six patients received corticosteroids. The mortality rate within four weeks was 56%, and the one-year survival was 27%. In the survivors, severity indexes were lower and 83% received corticosteroids. CONCLUSION: We observed a relatively high survival rate in patients with acute liver failure due to autoimmune hepatitis. This survival rate could be influenced by severity of the disease and/or use of corticosteroids.

关键词： Autoimmune hepatitis Acute liver failure Corticosteroids

Predictors of dehydration and acute renal failure in patients with diverting loop ileostomy creation after colorectal surgery

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World Journal of Clinical Cases 2019年第14期7卷 1805-1813页

作者： Omar Vergara-Fernández Mario Trejo-Avila Oscar Santes Danilo Solórzano-Vicu?a Noel Salgado-Nesme department of Colorectal Surgery Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"

BACKGROUND despite the potential benefits of fecal diversion after low pelvic anastomosis in colorectal surgery, diverting loop ileostomy construction is related to significant rates of complications. AIM To determine potential predictors of high output related complications in patients with diverting loop ileostomy creation after colorectal surgery. METHODS Patients who underwent open and laparoscopic colorectal surgery requiring a diverting loop ileostomy from January 2010 to March 2018 were retrospectively analyzed. We included patients older than 18 years, who underwent colorectal surgery with primary low pelvic anastomosis, and with the creation of a diverting loop ileostomy, at elective or emergency settings for the treatment of benign or malignant conditions. Univariate and multivariate logistic regression analysis was used to determine the effect of the potential predictors on the rate of high output related complications. The high output related complications were dehydration and acute renal failure that required visits to the emergency department and hospitalizations. RESULTS Of the 102 patients included in the study, 23.5%(n = 24) suffered high output related complications. In this group of patients at least one visit to the emergency department (mean 1.6), and at least one readmission to the hospital was needed. The factors associated with high-output ileostomy, in the univariate analysis, were: urgent surgical intervention (OR = 2.6;P = 0.047), the development of postoperative complications (OR = 3;P = 0.024), have ulcerative colitis (OR = 4.8;P = 0.017), use of steroids (OR = 4.3;P = 0.010), mean output at discharge greater than 1000 mL/24 h (OR = 3.2;P = 0.016), and use of loperamide at discharge (OR = 2.8;P = 0.032). Multivariate logistic regression analysis identified two independent risk factors for high output related complications: ulcerative colitis [OR = 7.6 (95%CI: 1.81-31.95);P = 0.006], and ileostomy output at discharge ≥ 1000 mL/24 h [OR =

关键词： Loop ileostomy High-output ileostomy Loop ileostomy complications dehydration Colorectal surgery

Follow-up of patients with pseudotumoral chronic pancreatitis: Outcome and surveillance

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World Journal of Gastroenterology 2014年第26期20卷 8612-8616页

作者： Félix Ignacio Téllez-ávila álvaro Villalobos-Garita Marc Giovannini Carlos Chan Jorge Hernández-Calleros Luis Uscanga Miguel ángel Ramírez-Luna Endoscopy department Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" Gastroenterology department Hospital Calderón GuardiaCCSS Endoscopic Unit Paoli-Calmettes Institute Surgery department Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" Gastroenterology department Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"

AIM: To follow up patients with pseudotumoral chronic pancreatitis (PCP) to assess their outcome and identify an optimal surveillance interval.

关键词： Chronic pancreatitis Pseudotumoral chronic pancreatitis Surveillance Endoscopic ultrasound

Diagnosis and treatment of hepatocellular carcinoma: An update

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World Journal of Hepatology 2015年第3期7卷 362-376页

作者： Javier Tejeda-Maldonado Ignacio García-Juárez Jonathan Aguirre-Valadez Adrián González-Aguirre Mario Vilatobá-Chapa Alejandra Armengol-Alonso Francisco Escobar-Penagos Aldo Torre Juan Francisco Sánchez-ávila Diego Luis Carrillo-Pérez department of Internal Medicine Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán department of Interventional Radiology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán department of Transplantation Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán department of Hematology and Oncology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Hepatocellular carcinoma(HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium "washout" in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis. The Barcelona Clinic Liver Cancer staging method is the most frequently used worldwide and recommended by the international guidelines of HCC management. Currently available treatments include tumor resection, liver transplant, sorafenib and locoregional therapies(alcoholization, radiofrequency ablation, chemoembolization). The prognosis of hepatocarcinoma is determined according to the lesion's stage and in cirrhotic patients, on residual liver function. Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib.

关键词： Hepatocellular carcinoma Surveillance Liver transplant Sorafenib Catheter ablation

Sarcopenia in patients with colorectal cancer:A comprehensive review

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World Journal of Clinical Cases 2020年第7期8卷 1188-1202页

作者： Omar Vergara-Fernandez Mario Trejo-Avila Noel Salgado-Nesme department of Colorectal Surgery Instituto Nacional de Ciencias Medicas y Nutrición“Salvador Zubirán”Mexico 14080Mexico

Colorectal cancer(CRC)is the third most commonly diagnosed cancer globally and the second cancer in terms of *** prevalence of sarcopenia in patients with CRC ranges between 12%-60%.Sarcopenia comes from the Greek“sarx”for flesh,and“penia”for *** is considered a phenomenon of the aging process and precedes the onset of frailty(primary sarcopenia),but sarcopenia may also result from pathogenic mechanisms and that disorder is termed secondary *** diagnosis is confirmed by the presence of low muscle quantity or *** parameters need to be measured:muscle strength,muscle quantity and physical *** standard method to evaluate muscle mass is by analyzing the tomographic total cross-sectional area of all muscle groups at the level of lumbar 3rd *** may negatively impact on the postoperative outcomes of patients with colorectal cancer undergoing surgical *** has been described an association between sarcopenia and numerous poor short-term CRC outcomes like increased perioperative mortality,postoperative sepsis,prolonged length of stay,increased cost of care and physical *** may also negatively impact on overall survival,disease-free survival,recurrence-free survival,and cancerspecific survival in patients with non-metastatic and metastatic colorectal ***,patients with sarcopenia seem prone to toxic effects during chemotherapy,requiring dose deescalations or treatment delays,which seems to reduce treatment efficacy.A multimodal approach including nutritional support(dietary intake,high energy,high protein,and omega-3 fatty acids),exercise programs and anabolic-orexigenic agents(ghrelin,anamorelin),could contribute to muscle mass *** of sarcopenia screening to the established clinical-pathological scores for patients undergoing oncological treatment(chemotherapy,radiotherapy or surgery)seems to be the next step for the best of care of CRC pati

关键词： Colorectal cancer Sarcopenia Nutrition Muscle mass loss Oncologic outcomes Survival

Association of the HLA-DRB1*0701 allele with perinuclear anti-neutrophil cytoplasmatic antibodies in Mexican patients with severe ulcerative colitis

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World Journal of Gastroenterology 2006年第10期12卷 1617-1620页

作者： Jesus K Yamamoto-Furusho Luis Uscanga-Domínguez Alondra Lopez-Martinez Julio Granados department of Gastroenterology Institute Nacional de Ciencias Médicas y nutrición Salvador Zubirán.México D FMéxico department of Immunology Institute Nacional de Ciencias Médicas y nutrición Salvador Zubirán.México D FMéxico

AIM： To determine the association between the HLADRB1 alleles and perinuclear anti-neutrophil cytoplasmatic antibodies （p-ANCA） positive in Mexican patients with ulcerative colitis （UC）. METHODS： Ninety Mexican mestizo patients （45 females） with UC, confirmed by biopsy, were studied. High resolution HLA typing was performed by PCR-SSO reverse dot blot and PCR-SSP. Molecular typing techniques were applied to define HLA-DRB1 alleles. Enzyme-linked immunosorbent assay and immunofluorescence techniques were used to detect p-ANCA. RESULTS： Forty-eight （53%） UC patients were positive for p-ANCA by ELISA and IF. We found that p-ANCA- positive UC patients had a significantly increased frequency of HLA-DR7 compared with p-ANCA-negative controls （22% vs 5.1%; pC=0.02, OR=5.2, CI 95%： 1.06-37.82）. Disease activity was scored as severe in 20 patients, moderate in 8, mild in 14 and no activity in the remaining 38 patients according to the Truelove and Witts criteria. Subgroup analysis showed a significantly increased frequency of the HLA-DRB1＊07 allele in 15 of 20 UC patients with severe activity of UC and p-ANCA positivity [100% vs 0%; pC=0.0000001; OR=35]. No significant differences were found between p-ANCA positive patients, HLA-DR alleles and other clinical features such as extraintestinal manifestations, proctocolectomy and ***： The HLA-DRB1＊07 is associated with p-ANCA positive UC Mexican patients.

关键词： HLA-DR p-ANCA Ulcerative colitis Mexicans