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Gallbladder tuberculosis: False-positive PET diagnosis of gallbladder cancer

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World Journal of Gastroenterology 2006年第40期12卷 6559-6560页

作者： JM Ramia K Muffak A Fernández J Villar D Garrote JA Ferron Unidad de Cirugía Hepatobiliopancreaticay Trasplante Hepático Servicio de Cirugía Generaly Aparato Digestivo Granada Spain servicio de Medicina Nuclear Hospital Universitario Virgen de las Nieves Granada Spain

Gallbladder tuberculosis (GT) is an extremely rare disease, and very few cases have been reported in the literature. The first case of GT was described in 1870 by Gaucher. A correct preoperative diagnosis of GT is unusual, and it is frequently confused with various gallbladder diseases. We present a new case of a patient who underwent surgery with the preoperative diagnosis of gallbladder cancer after a false positive positron emission tomography scan in the diagnostic work-up.

关键词： Positron emission tomography, Gallbladder Tuberculosis, Cancer, Review

CCL2-2518 A/G and CCR2 190 A/G do not influence the outcome of hepatitis C virus infection in the Spanish population

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World Journal of Gastroenterology 2007年第15期13卷 2187-2192页

作者： MA Montes-Cano JR García-Lozano J Aguilar-Reina M Romero-Gómez N Barroso A Nú(n|~)ez-Roldán MF González-Escribano servicio de Inmunologia Hospital Universitario Virgen del Rocío Spain servicio de digestivo Hospital Universitario Virgen del Rocío Spain Sección Hepatología. Hospital Universitario de Valme. servicio Andaluz de Salud Seville Spain

AIM： To assess whether CCL2 or interactions between this chemokine and its receptor （CCR2） are associated with outcomes of chronic hepatitis C and with responses to antiviral therapy. METHODS： Two hundred and eighty-four patients with chronic hepatitis C and 193 non-infected matched controls were included in this study. Patients were categorized according to their Scheuer score of hepatic fibrosis as F0-F2 （/7 = 202） or F3-F4 （/7 = 82） and according to their response to anti-Hepatitis C virus （HCV） therapy as sustained response （SR, n = 201） or non-sustained response （NSR, n = 98）. Genotyping of the -2518 （A/G） CCL2 was performed using PCR-RFLP, genotyping of the 190 （A/G） CCR2 using a PCR-ARMS system, and genotyping of the rs3138042 （G/A） CCR2 using Taqman probes. RESULTS： Univariate analyses identified 4 parameters （infection duration time, viral genotype, gender and AST levels） that tended to influence fibrosis and 7 parameters （CCL2G, CCL2ACCR2A, viremia levels, fibrosis stage, viral genotype, infection duration time and AST levels） that significantly influenced or tended to influence response to treatment. Multivariate analysis identified gender and AST levels as parameters that independently influenced fibrosis stage and viral genotype and infection duration time were the two parameters that independently influenced response to treatment. CONCLUSION： Our results indicate that the mutations studied in the gene pair CCL2/CCR2 do not play a major role in the outcome and response to treatment for HCV infection in the Spanish population.

关键词： CCL2 CCR2 Polymorphism Hepatitis C virus Treatment Fibrosis stage

Stem cell therapy in inflammatory bowel disease: A promising therapeutic strategy?

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World Journal of Stem Cells 2015年第2期7卷 343-351页

作者： Ana I Flores Gonzalo J Gómez-Gómez ángeles Masedo-González M Pilar Martínez-Montiel servicio de Aparato digestivo Hospital 12 de OctubreAvda. de Córdoba28041 MadridSpain

Inflammatory bowel diseases are inflammatory, chronic and progressive diseases of the intestinal tract for which no curative treatment is available. Research in other fields with stem cells of different sources and with immunoregulatory cells(regulatory T-lymphocytes and dendritic T-cells) opens up new expectations for their use in these diseases. The goal for stem cell-based therapy is to provide a permanent cure. To achieve this, it will be necessary to obtain a cellular product, original or genetically modified, that has a high migration capacity and homes into the intestine, has high survival after transplantation, regulates the immune reaction while not being visible to the patient's immune system, and repairs the injured tissue.

关键词： Mesenchymal stem cell Hematopoieticstem cell Inflammatory bowel disease Crohn's disease Ulcerative colitis Amniotic fluid stem cells Inducedpluripotent stem cells Intestinal stem cells Endothelialprogenitor cells Tolerogenic immune cell therapies

Hydatid cyst of the colon:A systematic review of the literature

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World Journal of Clinical Cases 2019年第13期7卷 1634-1642页

作者： Miguel Angel Latatu-Córdoba Sergio Ruiz-Blanco Matilde Sanchez Carmen Santiago-Boyero Paula Soto-García Wenzhong Sun José M Ramia Faculty of Medicine Universidad of Alcalá Alcalá de Henares 28801 Spain servicio de Cirugía Generaly del Aparato digestivo Hospital Universitario de Guadalajara Guadalajara 19002 Spain

BACKGROUND Primary hydatid disease in the colon is an extremely rare finding. We performed a systematic review of cases of hydatidosis of the colon published to date. AIM To systematic review the published papers about hydatidosis of the colon. METHODS Following PRISMA guidelines, we performed an unlimited search for articles on CH in the MEDLINE (PubMed), EMBASE, Cochrane, Latindex and Scielo databases, published in English, Spanish, French, German or Italian between January 1, 1960 and december 15, 2018. The search items were:(Colon) AND [(hydatidosis) OR (hydatid disease) OR (echinococcosis)]. RESULTS Nine case reports were found [five men, four women, median age 64.55 years (range: 21-81)]. The most frequent clinical manifestation was abdominal pain (8/9)(88.9%). In almost all cases several image studies were carried out, but abdominal computed tomography was the most used (66.7%). Five resections of the colon (62.5%) and three sutures of the fistula between cyst and colon (37.5%) were performed. Four patients did not present post-operative complications, but one died. Postoperative period was recorded for a mean period of 35 months. No recurrences were recorded. CONCLUSION The most frequent symptom was abdominal pain (evidence level 4). Computed tomography was the most frequently used diagnostic imaging technique (evidence level 4). Colectomy was the most appropriate treatment (evidence level 5). All the diagnostic and therapeutic options for hydatid cysts located in colon have a low level of evidence.

关键词： Echinococcosis Hydatidosis Hydatid cyst Colon Surgery Review

Hydatid cyst of the gallbaldder: A systematic review of the literature

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World Journal of Hepatology 2016年第25期8卷 1087-1092页

作者： Roberto Gómez Yousef Allaoua Rafael Colmenares Sergio Gil Pilar Roquero José M Ramia Faculty of Medicine Universidad de Alcalá servicio de Cirugía General y del Aparato digestivo Hospital Universitario de Guadalajara

AIM To evaluate all the references about primary gallbladder hidatidosis looking for best treatment *** Search:1966-2015 in MEDLINE,Cochrane Library,SciELO,and *** words: "gallabladder hydatid disease" and "gallbladder hydatid cyst".We found 124 papers in our searches but only 14 papers including 16 cases were about hydatid cyst of the gallbladder(GBHC).RESULTS Eight cases of GBHC were women and seven *** not *** age was 48.3 *** most frequent clinical symptom was abdominal pain(94%) usually in the right upper *** was performed in ten patients(62.5%) but in most cases a combination of several techniques was *** location of the cysts was intravesicular in five *** patients presented GBHC and liver hydatid *** patients presented cholelithiasis and one *** most frequent surgical technique was cholecystectomy by laparotomy(81.25%).Simultaneous surgery of liver cysts was carried out in five *** patients did not present postoperative complications,but one *** mean hospital stay was seven *** recurrence of GBHC was *** In GBHC,the most frequent symptom is right hypocondrium pain(evidence level V).Best diagnostic methods are ultrasound and computed tomography(level V,grade D).Suggested treatment is open cholecystectomy and postoperative albendazole(level V,grade D) obtaining good clinical results and none relapses.

关键词： Hydatid cyst Gallbladder Cholecystectomy Review Hydatidosis

Stem cell therapy applied for digestive anastomosis: Current state and future perspectives

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World Journal of Stem Cells 2022年第1期14卷 117-141页

作者： Jacobo Trébol Tihomir Georgiev-Hristov Isabel Pascual-Miguelañez Hector Guadalajara Mariano García-Arranz Damian García-Olmo servicio de Cirugía General y del Aparato digestivo Complejo Asistencial Universitario de SalamancaSalamanca 37007Spain departamento de Anatomía e Histología Humanas Universidad de SalamancaSalamanca 37007Spain servicio de Cirugía General y del Aparato digestivo Hospital General Universitario de VillalbaMadrid 28400Spain servicio de Cirugía General y del Aparato digestivo Hospital Universitario La PazMadrid 28046Spain servicio de Cirugía General y del Aparato digestivo Hospital Universitario Fundación Jiménez DíazMadrid 28040Spain Grupo de Investigación en Nuevas Terapias Instituto de Investigación Sanitaria-Fundación Jiménez DíazMadrid 28040Spain Damian García-Olmo Departamento de CirugíaUniversidad Autónoma de MadridMadrid 28029Spain servicio de Cirugía General y del Aparato digestivo Hospital Universitario Fundación Jiménez Díaz y Grupo Quiron-Salud MadridMadrid 28040Spain

BACKGROUND Digestive tract resections are usually followed by an *** leakage,normally due to failed healing,is the most feared complication in digestive surgery because it is associated with high morbidity and *** technical and technological advances and focused research,its rates have remained almost unchanged the last *** the last two decades,stem cells(SCs)have been shown to enhance healing in animal and human studies;hence,SCs have emerged since 2008 as an alternative to improve anastomoses *** To summarise the published knowledge of SC utilisation as a preventative tool for hollow digestive viscera anastomotic or suture *** PubMed,Science Direct,Scopus and Cochrane searches were performed using the key words“anastomosis”,“colorectal/colonic anastomoses”,“anastomotic leak”,“stem cells”,“progenitor cells”,“cellular therapy”and“cell therapy”in order to identify relevant articles published in English and Spanish during the years of 2000 to *** employing SCs,performing digestive anastomoses in hollow viscera or digestive perforation sutures and monitoring healing were finally *** lists from the selected articles were reviewed to identify additional pertinent *** Given the great variability in the study designs,anastomotic models,interventions(SCs,doses and vehicles)and outcome measures,performing a reliable meta-analysis was considered impossible,so we present the studies,their results and *** Eighteen preclinical studies and three review papers were identified;no clinical studies have been published and there are no registered clinical *** studies,mainly in rat and porcine models and occasionally in very adverse conditions such as ischaemia or colitis,have been demonstrated SCs as safe and have shown some encouraging morphological,functional and even clinical *** SCs are mostly employed,and delivery routes are mainly local

关键词： Surgical anastomosis Anastomotic leak Digestive system surgical procedure Cell transplantation Cell therapy Stem cells Tissue engineering

Management of betablocked patients after sustained virological response in hepatitis C cirrhosis

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World Journal of Gastroenterology 2019年第21期25卷 2665-2674页

作者： Marta Abadía María Luisa Montes Dolores Ponce Consuelo Froilán Miriam Romero Joaquín Poza Teresa Hernández Rubén Fernández-Martos Antonio Olveira Antonio Olveira Servicio de Aparato DigestivoHospital Universitario La PazMadrid 28046Spain Unidad VIH Servicio de Medicina InternaHospital Universitario La PazMadrid 28046Spain servicio de Radiología Hospital Universitario La PazMadrid 28046Spain CIBERehd IdiPAZ Madrid 28029Spain

BACKGROUND Current guidelines do not address the post–sustained virological response management of patients with baseline hepatitis C virus (HCV) cirrhosis and oesophageal varices taking betablockers as primary or secondary prophylaxis of variceal bleeding. We hypothesized that in some of these patients portal hypertension drops below the bleeding threshold after sustained virological response, making definitive discontinuation of the betablockers a safe option. AIM To assess the evolution of portal hypertension, associated factors, non-invasive assessment, and risk of stopping betablockers in this population. METHODS Inclusion criteria were age > 18 years, HCV cirrhosis (diagnosed by liver biopsy or transient elastography > 14 kPa), sustained virological response after directacting antivirals, and baseline oesophageal varices under stable, long-term treatment with betablockers as primary or secondary bleeding prophylaxis. Main exclusion criteria were prehepatic portal hypertension, isolated gastric varices, and concomitant liver disease. Blood tests, transient elastography, and upper gastrointestinal endoscopy were performed. Hepatic venous pressure gradient (HVPG) was measured five days after stopping betablockers. Betablockers could be stopped permanently if gradient was der treatment with propranolol or carvedilol: median age 64 years, men 54.5%, median Model for End-Stage Liver Disease (MELD) score 9, Child-Pugh score A 77%, median platelets 77.000 × 103/μL, median albumin 3.9 g/dL, median baseline transient elastography 24.8 kPa, 88% of patients received primary prophylaxis. Median time from end of antivirals to gradient was 67 wk. Venous pressure gradient was decrease from baseline. On endoscopy, variceal size regressed in 19/27 patients (70%), although gradient was

关键词： Hepatitis C virus Oesophageal varices Portal hypertension Betablocker Variceal bleeding

Refractory hepatic encephalopathy in a patient with hypothyroidism: Another element in ammonia metabolism

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World Journal of Gastroenterology 2017年第28期23卷 5246-5252页

作者： Fernando Díaz-Fontenla Marta Castillo-Pradillo Arantxa Díaz-Gómez Luis Ibanez-Samaniego Pilar Gancedo Juan Adan Guzmán-de-Villoria Pilar Fernández-García Rafael Banares-Canizares Rita García-Martínez Unidad de Hepatología Servicio de Aparato DigestivoHospital General Universitario Gregorio Maranón Instituto de Investigación Sanitaria Hospital Gregorio Maranón servicio de Aparato digestivo Hospital Santa Bárbara servicio de Radiodiagnóstico Hospital General Universitario Gregorio Maranón Centro de Investigación Biomédica en Red de Salud Mental Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Facultad de Medicina Universidad San Pablo CEU

Hepatic encephalopathy(HE) remains a diagnosis of exclusion due to the lack of specific signs and symptoms. Refractory HE is an uncommon but serious condition that requires the search of hidden precipitating events(i.e.,portosystemic shunt) and alternative diagnosis. Hypothyroidism shares clinical manifestations with HE and is usually considered within the differential diagnosis of HE. Here,we describe a patient with refractory HE who presented a large portosystemic shunt and post-ablative hypothyroidism. Her cognitive impairment,hyperammonaemia,electroencephalograph alterations,impaired neuropsychological performance,and magnetic resonance imaging and spectroscopy disturbances were highly suggestive of HE,paralleled the course of hypothyroidism and normalized after thyroid hormone replacement. There was no need for intervention over the portosystemic shunt. The case findings support that hypothyroidism may precipitate HE in cirrhotic patients by inducing hyperammonaemia and/or enhancing ammonia brain toxicity. This case led us to consider hypothyroidism not only in the differential diagnosis but also as a precipitating factor of HE.

关键词： Hepatic encephalopathy Hypothyroidism Cognitive impairment Cirrhosis Portosystemic shunt Magnetic resonance spectroscopy

Treatment of chronic hepatitis C with direct-acting antivirals: The role of resistance

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World Journal of Gastroenterology 2016年第29期22卷 6573-6581页

作者： Miguel Jiménez-Pérez Rocío González-Grande Pilar Espana Contreras Isabel Pinazo Martínez Jesús de la Cruz Lombardo Raúl Olmedo Martín UGC de Aparato digestivo Unidad de Hepatologia-Trasplante Hepatico Hospital Universitario Regional de Malaga 29010 Malaga Spain Liver transplantation and hepatology unit UGC de Aparato Digestivo Hospital Regional Universitario 29010 Malaga Spain

The use of direct-acting antivirals(DAAs) to treat chronic hepatitis C has resulted in a significant increase in rates of sustained viral response(around 90%-95%) as compared with the standard treatment of peginterferon/ribavirin. despite this, however, the rates of therapeutic failure in daily clinical practice range from 10%-15%. Most of these cases are due to the presence of resistant viral variants, resulting from mutations produced by substitutions of amino acids in the viral target protein that reduce viral sensitivity to DAAs, thus limiting the efficacy of these drugs. The high genetic diversity of hepatitis C virus has resulted in the existence of resistance-associated variants(RAVs), sometimes even before starting treatment with DAAs, though generally at low levels. These preexisting RAVs do not appear to impact on the sustained viral response, whereas those that appear after DAA therapy could well be determinant in virological failure with future treatments. As well as the presence of RAVs, virological failure to treatment with DAAs is generally associated with other factors related with a poor response, such as the degree of fibrosis, the response to previous therapy, the viral load or the viral genotype. Nonetheless, viral breakthrough and relapse can still occur in the absence of detectable RAVs and after the use of highly effective DAAs, so that the true clinical impact of the presence of RAVs in therapeutic failure remains to be determined.

关键词： Direct-acting antivirals Resistance Treatment Hepatitis C virus