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Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic:Short and middle term outcomes

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World Journal of Methodology 2024年第2期14卷 107-126页

作者： Jacobo Trébol Ana Carabias-Orgaz María Carmen Esteban-Velasco Asunción García-Plaza Juan Ignacio González-Munoz Ana Belén Sánchez-Casado Felipe Carlos Parreno-Manchado Marta Eguía-Larrea José Antonio Alcázar-Montero Cirugía General y del aparato digestivo Complejo Asistencial Universitario de SalamancaSalamanca 37007SalamancaSpain Cirugía Universidad de SalamancaSalamanca 37007SalamancaSpain Oftalmología Complejo Asistencial Universitario de SalamancaSalamanca 37007SalamancaSpain

BACKGROUND The first wave of coronavirus disease 2019(COVID-19)pandemic in Spain lasted from middle March to the end of June *** population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable *** our centre,we managed patients previously and newly diagnosed with *** established a strategy based on limiting perioperative social contacts,preoperative screening(symptoms and reverse transcriptionpolymerase chain reaction)and creating separated in-hospital COVID-19-free pathways for non-infected *** also adopted some practice modifications(surgery in different facilities,changes in staff and guidelines,using continuously changing personal protective equipment…),that supposed new *** To analyse cancer patients with a decision for surgery managed during the first wave,focalizing on outcomes and pandemic-related *** We prospectively included adults with a confirmed diagnosis of colorectal,oesophago-gastric,liver-pancreatic or breast cancer with a decision for surgery,regardless of whether they ultimately underwent *** analysed short-term outcomes[30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection]and outcomes after 3 years(adjuvant therapies,oncological events,death,SARS-CoV-2 infection and vaccination).We also investigated modifications to usual *** From 96 included patients,seven didn’t receive treatment that period and four never(3 due to COVID-19).Operated patients:28 colon and 21 rectal cancers;laparoscopy 53.6%/90.0%,mortality 3.57%/0%,major complications 7.04%/25.00%,anastomotic leaks 0%/5.00%,3-years disease-free survival(DFS)82.14%/52.4%and overall survival(OS)78.57%/76.2%.Six liver metastases and six pancreatic cancers:no mortality,one major complication,three grade A/B liver failures,one bile leak;3-year DFS 0%/33.3%and OS 50.0%/33.3%(liver metastases/pancreatic carcinoma).5 g

关键词： COVID-19 SARS-CoV-2 Colon cancer Rectal cancer Breast cancer Liver cancer Pancreatic cancer Gastric cancer Oesophageal cancer Surgery

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Metabolic complications in liver transplant recipients

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World Journal of Gastroenterology 2016年第28期22卷 6416-6423页

作者： Miguel Jiménez-Pérez Rocío González-Grande Edith Omonte Guzmán Víctor Amo Trillo Juan Miguel Rodrigo López UGC de aparato digestivo Unidad de Hepatología-Trasplante Hepático Hospital Universitario Regional de Málaga

The metabolic syndrome(MS), which includes obesity,dyslipidaemia, hypertension and hyperglycaemia according to the most widely accepted definitions now used, is one of the most common post-transplant complications, with a prevalence of 44%-58%. The MS, together with the immunosuppression, is considered the main risk factor for the development of cardiovascular disease(CVD) in transplant recipients, which in turn accounts for 19%-42% of all deaths unrelated to the graft. The presence of MS represents a relative risk for the development of CVD and death of 1.78. On the other hand, non-alcoholic fatty liver disease(NAFLD), considered as the manifestation of the MS in the liver, is now the second leading reason for liver transplantation in the United States after hepatitis C and alcohol. NAFLD has a high rate of recurrence in the liver graft and a direct relation with the worsening of other metabolic disorders, such as insulin resistance or diabetes mellitus. Consequently, it is vitally important to identify and treat as soon as possible such modifiable factors as hypertension, overweight, hyperlipidaemia or diabetes in transplanted patients to thus minimise the impact on patient survival. Additionally, steroid-free regimens are favoured, with minimal immunosuppression to limit the possible effects on the development of the MS.

关键词： Metabolic syndrome Liver transplantation Immunosuppressions Risk factors Non-alcoholic fatty liver disease

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Application of artificial intelligence in the diagnosis and treatment of hepatocellular carcinoma: A review

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World Journal of Gastroenterology 2020年第37期26卷 5617-5628页

作者： Miguel Jimenez Perez Rocio Gonzalez Grande UGC de aparato digestivo Unidad de Hepatologia-Trasplante HepaticoHospital Regional Universitario de MalagaMalaga 29010Spain

Although artificial intelligence(AI)was initially developed many years ago,it has experienced spectacular advances over the last 10 years for application in the field of medicine,and is now used for diagnostic,therapeutic and prognostic purposes in almost all *** application in the area of hepatology is especially relevant for the study of hepatocellular carcinoma(HCC),as this is a very common tumor,with particular radiological characteristics that allow its diagnosis without the need for a histological ***,the interpretation and analysis of the resulting images is not always easy,in addition to which the images vary during the course of the disease,and prognosis and treatment response can be conditioned by multiple *** vast amount of data available lend themselves to study and analysis by AI in its various branches,such as deeplearning(DL)and machine learning(ML),which play a fundamental role in decision-making as well as overcoming the constraints involved in human *** is a form of AI based on automated learning from a set of previously provided data and training in algorithms to organize and recognize *** is a more extensive form of learning that attempts to simulate the working of the human brain,using a lot more data and more complex *** review specifies the type of AI used by the various ***,welldesigned prospective studies are needed in order to avoid as far as possible any bias that may later affect the interpretability of the images and thereby limit the acceptance and application of these models in clinical *** addition,professionals now need to understand the true usefulness of these techniques,as well as their associated strengths and limitations.

关键词： Artificial intelligence Machine learning Hepatocellular carcinoma Diagnosis Treatment Prognosis

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Present and future management of viral hepatitis

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World Journal of Gastroenterology 2021年第47期27卷 8081-8102页

作者： Rocío González Grande Inmaculada Santaella Leiva Susana López Ortega Miguel Jiménez Pérez UGC de aparato digestivo.unidad de Hepatología-Trasplante Hepático Hospital Regional Universitario de MálagaMálaga 29010Spain

Viral hepatitis can result in important morbidity and mortality,with its impact on health conditioned by the specific type of hepatitis,the geographical region of presentation and the development and access to new drugs,among other *** acute presentation forms are self-limiting and may even go unnoticed,with just a small percentage of cases leading to acute liver failure that may necessitate transplantation or even cause the death of the ***,when they become chronic,as in the case of hepatitis B virus and C virus,unless they are diagnosed and treated adequately they may have severe consequences,like cirrhosis or *** of the mechanisms of transmission,the pathogenesis,the presence of vaccinations and the development over recent years of new highly-efficient,potent drugs have meant that we are now faced with a new scenario in the management of viral hepatitis,particularly hepatitis B virus and hepatitis C *** spectacular advances in hepatitis C virus treatment have led the World Health Organization to propose the objective of its eradication by *** key aspect to achieving this goal is to ensure that these treatments reach all the more vulnerable population groups,in whom the different types of viral hepatitis have a high prevalence and constitute a niche that may perpetuate infection and hinder its ***,microelimination programs assume special relevance at the present time.

关键词： Hepatitis viral Diagnosis Treatment Trend direct-acting antivirals Inhibiting recycling

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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

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Internal anal sphincter augmentation and substitution

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Gastroenterology Report 2014年第2期2卷 106-111页

作者： Fernando de la Portilla unidad de Gestion Clinica de Cirugia General y del aparato digestivo Instituto de Biomedicina de Sevilla(IBIS)SevilleSpain

There is an increasing recognition of the importance of internal anal sphincter(IAS)dysfunction presenting as passive faecal *** problem may manifest after anal sphincterotomy or following the more minimally invasive operations for haemorrhoids,as well as with advancing *** of the poor results of IAS plication and the beneficial outcomes with peri-urethral bulking agents in urology,these materials have been developed for use in IAS *** review outlines the basic purported mechanisms of action,defining the materials in clinical use,their methods of deployment,complications and reported *** is still much that is unknown concerning the ideal agent or the volume and the technique of deployment,which will only be answered by powerful,prospective,randomized,controlled *** specific role of autologous stem cells designed to regenerate the sphincters in cases of functional impairment or muscle loss is yet to be seen.

关键词： faecal incontinence internal anal sphincter dysfunction internal anal sphincter augmentation bulking agents

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Timing of surgery in Crohn’s disease: A key issue in the management

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World Journal of Gastroenterology 2008年第36期14卷 5532-5539页

作者： Rafael Alós Joaquín Hinojosa Servicio de Cirugía General Unidad de Coloproctología Hospital de Sagunto Valencia Spain unidad de digestivo Servicio de Medicina Interna Hospital de Sagunto Valencia Spain

The timing of the decision for operation in Crohn’s disease is based on an evaluation of the several factors such as the failure of medical treatment, complications due to the Crohn’s disease or to the farmacological therapy, development of dysplasia or cancer and growth retardation. A complete evaluation of these factors should result in operation timed to the patient’s best advantage, achieving maximal relief of symptoms with improvement of quality of life. Given the complexity and heterogeneity of the disease and the different options for treatment, is difficult to systematize when the optimal moment for the surgery is arrived. A very important factor in the management of Crohn’s disease is the multidisciplinary approach and the patient preference should be a significant factor in determining the choice of therapy. The surgery should be considered such another option in the sequential treatment of Crohn’s disease. We have analyzed the factors that are involved in the decision taking of the surgical treatment regarding to the experience and the published literature. When did the medical therapy fail? when is the appropriate moment to operate on the patient? Or which complications of Crohn’s disease need a surgery? These are some of the questions we will try to answer.

关键词： Crohn's disease Surgical treatment Medical therapy

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Management of recurrent hepatitis C virus after liver transplantation

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World Journal of Gastroenterology 2014年第44期20卷 16409-16417页

作者： Miguel Jiménez-Pérez Rocío González-Grande Francisco Javier Rando-Mu?oz Liver transplantation and hepatology unit UGC de Aparato Digestivo Hospital Regional Universitario department of Abdominal Diseases Hospital Nij Smellinghe Ziekenhuis

Chronic hepatitis C virus (HCV) infection is the leading cause of death from liver disease and the leading indication for liver transplantation (LT) in the United States and Western Europe. LT represents the best therapeutic alternative for patients with advanced chronic liver disease caused by HCV or those who develop hepatocarcinoma. Reinfection by HCV of the graft is universal and occurs in 95% of transplant patients. This reinfection can compromise graft function and patient survival. In a few cases, the histological recurrence is minimal and non-progressive; however, in most patients it follows a more rapid course than in immunocompetent persons, and frequently evolves into cirrhosis with graft loss. In fact, the five-year and ten-year survival of patients transplanted because of HCV are 75% and 68%, respectively, compared with 85% and 78% in patients transplanted for other reasons. There is also a pattern of recurrence that is very severe, but rare (< 10%), called fibrosing cholestatic hepatitis, which often involves rapid graft loss. Patients who present a negative HCV viremia after antiviral treatment have better survival. Many studies published over recent years have shown that antiviral treatment of post-transplant HCV hepatitis carried out during the late phase is the best option for improving the prognosis of these patients. Until 2011, PEGylated interferon plus ribavirin was the standard of care, resulting in a sustained virological response in around 30% of recipients. The addition of protease inhibitors, such as boceprevir or telaprevir, to the standard of care, or the use of other direct-acting antiviral drugs may involve therapeutic changes in the context of HCV recurrence. This may result a better prognosis for these patients, particularly those with severe recurrence or factors predicting rapid progression of fibrosis. However, the use of these agents in LT still requires clarification in terms of safety and efficacy.

关键词： Hepatitis C virus Liver transplantation Recurrence Treatment

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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

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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

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