http://hdl.handle.net/10171/22878 2013-05-24T19:11:14Z http://hdl.handle.net/10171/22906 Title: Hernia de Morgagni Author(s) : Pedano, N. (Nicolás); Rotellar, F. (Fernando); Marti-Cruchaga, P. (Pablo); Cienfuegos, J.A. (Javier A.) 2009-12-31T23:00:00Z http://hdl.handle.net/10171/22905 Title: Esofagectomía transhiatal por vía abierta y vía laparoscópica para el cáncer de esófago: análisis de los márgenes de resección y ganglios linfáticos Author(s) : Valenti, V. (Víctor); Fares, R. (Rally); Reynolds, N. (Neal); Cohen, P. (Patricia); Theodoro, N. (Nick); Martinez-Isla, A. (Alberto) Abstract: Surgical treatment of cancer of the oesophagus is associated with a high morbidity and mortality. Minimally invasive surgery has been proposed as an alternative to try to reduce these complications; however, at this time there are not many studies that evaluate the oncological validity of this method. The objective of this work is to give a preliminary audit of the results of our experience in both surgical techniques, with special emphasis on the oncopathological aspects (resection margins and lymph nodes). MATERIAL AND METHOD: Between April 2003 and February 2007, 40 patients diagnosed with distal oesophageal cancer were surgically intervened at Charing Cross Hospital, London, 24 open and 16 by laparoscopy in accordance with the surgeon responsible. Of these, 50% received neoadjuvant chemotherapy. Both groups were homogeneous for age, sex, ASA, tumour stage and tumour location. In all cases, the pathological tumour stage (TNM), the tumour distal margin, tumour proximal margin, tumour circumference and number of resected lymph nodes, were collected in a data base. RESULTS: The number of resected lymph nodes was similar in both groups; (19 for open and 18 for laparoscopy). The mean distal tumour margin for the group treated by open surgery was 4.9 cm compared to 4.3 in the group treated by laparoscopy (p = 0.578). The mean proximal tumour margin for the group treated by open surgery was 8.4 cm compared to 4.6 cm in the laparoscopy group (p = 0.004) and tumour circumference margin was positive in 11 patients (45%) belonging to the open group compared to 5 patients (33%) in the laparoscopy group (p = 0.519). CONCLUSIONS: In our experience, laparoscopic surgery for cancer of the oesophagus appears to show similar initial results to those of open surgery as regards the number of resected lymph nodes and resection margins. 2007-12-31T23:00:00Z http://hdl.handle.net/10171/22879 Title: Tratamiento del quilotórax postoperatorio por toracoscopia tras la administración oral de una dieta rica en grasas Author(s) : Valenti, V. (Víctor); Martinez-Cecilia, D. (David); Gil, A. (Ángeles); Martinez-Isla, A. (Alberto) 2007-12-31T23:00:00Z http://hdl.handle.net/10171/22877 Title: Cirugía bariátrica laparoscópica: bypass gástrico proximal Author(s) : Rotellar, F. (Fernando); Pastor, C. (Carlos); Baixauli, J. (Jorge); Gil, A. (Aurora); Valenti, V. (Víctor); Poveda, I. (Ignacio); Marti-Cruchaga, P. (Pablo) Abstract: The spectacular increase in the prevalence of obesity in our society and the significant complications and comorbidities that it gives rise to have stimulated the interest of scientists and public in this pathology. Surgical treatment is at present the only efficient and lasting treatment for morbid obesity and in many cases it appreciably improves, and even definitively cures, associated complications such as the case of diabetes or hypertension. Amongst the different techniques of bariatric surgery, the gastric bypass (GBP) seems to be definitively establishing itself, since it offers an excellent balance between loss of weight (>70% of the excess), surgical risk and subsequent quality of life. The possibility of carrying out this technique employing a laparoscopic approach has improved its acceptance by doctors and patients while it has made it possible to reduce morbidity and mortality, length of hospital stay and costs. Proximal GBP is carried on those patients with an BMI <60 Kg/m2; for BMI >60 Kg/m2 the GBP employed is denominated distal. Between October 2003 and November 2005, our centre performed 55 laparoscopic proximal Roux-en-Y gastric bypasses via laparoscopy. These involved 42 women and 13 males with an average age of 44 years. The average BMI was 43.5 (35-55.8). The average basal weight was 116.15 Kg. There was no peroperative mortality, nor reinterventions. The BMI after 12 months was 28.4. The average basal weight was 74.2 Kg. Laparoscopic Roux-en-Y proximal gastric bypass is a safe and efficient technique for the treatment of morbid obesity. 2004-12-31T23:00:00Z http://hdl.handle.net/10171/22755 Title: Totally Laparoscopic Roux-en-Y Duct-to-Mucosa Pancreaticojejunostomy After Middle Pancreatectomy A Consecutive Nine-case Series at a Single Institution Author(s) : Rotellar, F. (Fernando); Pardo, F. (Fernando); Montiel, C. (Custodia); Benito, A. (Alberto); Martinez-Regueira, F. (Fernando); Poveda, I. (Ignacio); Marti-Cruchaga, P. (Pablo); Cienfuegos, J.A. (Javier A.) Abstract: To present the results of a series of laparoscopic middle pancreatectomies with roux-en-Y duct-to-mucosa pancreaticojejunostomy. SUMMARY OF BACKGROUND DATA: Middle pancreatectomy makes it possible to preserve pancreatic parenchyma in the resection of lesions that traditionally have been treated by distal splenopancreatectomy or cephalic duodenopancreatectomy. The laparoscopic approach could minimize the invasiveness of the procedure and enhance the benefits of middle pancreatectomy. METHODS: From March 2005 to October 2007, 9 consecutive patients with benign or low malignant potential lesions in the pancreatic neck or body underwent surgery. Laparoscopic middle pancreatectomy with a roux-en-Y duct-to-mucosa pancreaticojejunostomy was planned on all of them. In the first 2 patients, the pancreas was transected by endostapler; in the last 7, the staple line was reinforced with absorbable polymer membrane. RESULTS: The intervention was concluded laparoscopically in every case except 1 (laparoscopic-assisted) in which pancreaticojejunostomy was performed by means of minilaparotomy. Mortality was 0% and perioperative morbidity was 33%, (fistula of the cephalic stump in the first 2 patients (22%)). The pancreaticojejunostomy fistula rate was 0%. The median postoperative hospital stay was 5 days (range, 3-41). In the last 7 patients, in which pancreas was transected with staple line reinforcement material there were no stump fistulas; morbidity decreased to 14% and the median hospital stay was 4 days (range, 3-30). CONCLUSIONS: Laparoscopic middle pancreatectomy is feasible and safe. Duct-to-mucosa pancreaticojejunostomy can be performed safely using this approach. The method of pancreatic transection seems to be decisive in the incidence of cephalic stump fistulas. 2007-12-31T23:00:00Z http://hdl.handle.net/10171/22687 Title: Pancreatectomía central en tumores benignos del cuello del páncreas Author(s) : Valenti, V. (Víctor); Pardo, F. (Fernando); Rotellar, F. (Fernando); Gil, A. (Aurora); Cervera, M. (María); Pastor, C. (Carlos); Poveda, I. (Ignacio); Beunza, J.J. (Juan José); Cienfuegos, J.A. (Javier A.) Abstract: The surgical treatment of benign tumors of the neck of the pancreas usually consists of enucleation or formal pancreatectomy. Central pancreatectomy has been put forward because it has fewer major complications and can preserve endocrine and exocrine function. Between January 1999 and march 2003, three patients with benign tumors of the neck of the pancreas underwent central pancreatectomy. all patients underwent computed tomography scans, intraoperative ultrasound and frozen-section analysis. pathologic examination showed two mucinous cystadenomas and one serous cystadenoma. after a mean follow-up of 34 months, none of the patients has shown major complications or local recurrence, or has developed diabetes. In conclusion, central pancreatectomy is a useful technique for selected benign or low-grade malignant pancreatic tumors of the neck of the pancreas. 2004-12-31T23:00:00Z http://hdl.handle.net/10171/22685 Title: Liver Transplantation in Patients with Hepatocellular Carcinoma Across Milan Criteria Author(s) : Herrero, J.I. (José Ignacio); Sangro, B. (Bruno); Pardo, F. (Fernando); Quiroga, J. (Jorge); Iñarrairaegui, M. (Mercedes); Rotellar, F. (Fernando); Montiel, C. (Custodia); Alegre, F. (Félix); Prieto, J. (Jesús) Abstract: Milan criteria are the most frequently used limits for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC), but our previous experience with expanded criteria showed encouraging results. The aim of this study was to investigate whether our expanded Clinica Universitaria de Navarra (CUN) criteria (1 nodule up to 6 cm or 2-3 nodules up to 5 cm each) could be used to select patients with HCC for LT. Eighty-five patients with HCC fulfilling CUN criteria were included as candidates for LT. Survival of transplanted HCC patients was compared with survival of patients without HCC (n = 180). After the exclusion of 2 patients with tumor seeding of the chest wall due to pre-LT tumor biopsy, survival and recurrence rates were compared according to tumor staging. Twenty-six out of 85 (30%) patients exceeded Milan criteria. Twelve patients had tumor progression on the waiting list. Patients exceeding Milan criteria had a higher dropout rate due to tumoral progression. One-, 3-, 5-, 7-, and 10-year survival rates of the 73 transplanted HCC patients were 86%, 74%, 70%, 61%, and 50%, respectively. Survival of patients with HCC was significantly lower than that of patients without HCC, but by multivariate analysis, HCC was not associated with lower survival. Tumor recurrence and survival rates were similar for patients fulfilling Milan and CUN criteria. Pathological staging showed 55 patients within Milan criteria, 7 patients exceeding them but within CUN criteria, and 9 patients exceeding CUN criteria. Tumor recurrence rates were 2/55 (4%), 0/7 (0%), and 4/9 (44%) in each of these groups, respectively. In conclusion, following CUN criteria could increase the number of HCC patients who could benefit from LT, without worsening the results. Because of the short number of patients in this series, these data need external validation. 2007-12-31T23:00:00Z http://hdl.handle.net/10171/22679 Title: Trasplante hepático Author(s) : Herrero, J.I. (José Ignacio); Pardo, F. (Fernando); Quiroga, J. (Jorge); Rotellar, F. (Fernando) Abstract: Liver transplantation is an efficient therapeutic option for terminal hepatic diseases. The principal indications of liver transplantation are hepatic cirrhosis, hepatic tumours (mainly, hepotocellular carcinoma) and acute liver failure. Over the years, the absolute contraindications for a transplant have lessened. Surgical techniques have also undergone changes. The results of liver transplant have improved so that survival one year after the transplant is close to 90% and after five years some 80% of transplanted patients continue to live. 2005-12-31T23:00:00Z http://hdl.handle.net/10171/22604 Title: Cirugía laparoscópica hepática y pancreática Author(s) : Pardo, F. (Fernando); Rotellar, F. (Fernando); Valenti, V. (Víctor); Pastor, C. (Carlos); Poveda, I. (Ignacio); Marti-Cruchaga, P. (Pablo); Zozaya, G. (Gabriel) Abstract: The development of laparoscopic surgery also includes the more complex procedures of abdominal surgery such as those that affect the liver and the pancreas. From diagnostic laparoscopy, accompanied by laparoscopic echography, to major hepatic or pancreatic resections, the laparoscopic approach has spread and today encompasses practically all of the surgical procedures in hepatopancreatic pathology. Without forgetting that the aim of minimally invasive surgery is not a better aesthetic result but the reduction of postoperative complications, it is undeniable that the laparoscopic approach has brought great benefits for the patient in every type of surgery except, for the time being, in the case of big resections such as left or right hepatectomy or resections of segments VII and VIII. Pancreatic surgery has undergone a great development with laparoscopy, especially in the field of distal pancreatectomy due to cystic and neuroendocrine tumours where the approach of choice is laparoscopic. Laparoscopy similarly plays an important role, together with echolaparoscopy, in staging pancreatic tumours, prior to open surgery or for indicating suitable treatment. In coming years, it is to be hoped that it will continue to undergo an exponential development and, together with the advances in robotics, it will be possible to witness a greater impact of the laparoscopic approach on the field of hepatic and pancreatic surgery. 2004-12-31T23:00:00Z http://hdl.handle.net/10171/22586 Title: Cirugía laparoscópica biliar Author(s) : Marti-Cruchaga, P. (Pablo); Valenti, V. (Víctor); Pastor, C. (Carlos); Poveda, I. (Ignacio); Zozaya, G. (Gabriel); Rotellar, F. (Fernando) Abstract: The following article briefly sets out the possible new protocols that can be applied in biliary pathology, arising from the changes brought about by the appearance of new techniques of laparoscopic biliary surgery. It offers a synthesis of the latest and most novel articles on surgical technique and management in different biliary pathologies such as Choledocholithiasis and cholecystitis. It can be concluded that management will differ greatly, depending on the technical capacities of the centre that is called upon to deal with one of these pathologies. A standard protocol for everybody cannot thus be established at present. Teh differences between endoscopic retrograde cholangiopancreatography and intraoperative laparoscopic cholangiography have still to be demonstrated, it is not possible to make generalisations about whether one technique is more useful than the other. The same could be said about whether access to the main biliary path should be achieved through the cystic conduct or whether, on the contrary, a choledochotomy should be performed. 2004-12-31T23:00:00Z http://hdl.handle.net/10171/22483 Title: Increased circulating and visceral adipose tissue expression levels of YKL-40 in obesity-associated type 2 diabetes are related to inflammation: impact of conventional weight loss and gastric bypass Author(s) : Catalan, V. (Victoria); Gomez-Ambrosi, J. (Javier); Rodriguez, A. (Amaia); Ramirez, B. (Beatriz); Rotellar, F. (Fernando); Valenti, V. (Víctor); Silva, C. (Camilo); Gil, M.J. (María José); Salvador, J. (Javier); Frühbeck, G. (Gema) Abstract: Context: Plasma YKL-40 is elevated in patients with type 2 diabetes. The potential role of visceral adipose tissue (VAT) as a significant source of YKL-40 is unknown. Objective: In the study circulating and expression levels of YKL-40 were examined in VAT analyzing the contribution of adipocytes and stromovascular fraction cells (SVFCs).Wealso explored YKL-40’s implication in insulin resistance and inflammation and the effect of weight loss on plasma YKL-40 concentrations. PatientsandMethods: Samples obtained from 53 subjects were used in the study.Geneandprotein expression levels of YKL-40 were analyzed in VAT as well as in both adipocytes and SVFCs. In addition, circulating YKL-40 concentrations were measured before and after weight loss achieved either by Roux-en-Y gastric bypass (n 26) or after a conventional dietetic program (n 20). Results: Circulating concentrations and VAT expression of YKL-40 were increased in obese patients with type 2 diabetes (P 0.01) as well as associated with variables of insulin resistance and inflammation. No differences in YKL-40 expression levels between adipocytes and SVFCs were detected. Monocyte chemoattractant protein-1 and homeostasis model assessment emerged (P 0.01) as independent factors predicting circulating YKL-40. Elevated levels of YKL-40 in obese patients decreased after weight loss following a conventional hypocaloric diet (P 0.05) but not via a surgery-induced negative energy balance mediated by the Roux-en-Y gastric bypass. Conclusions: The association of increased YKL-40 mRNA and protein levels in VAT with its circulating concentrations indicates an important contribution of VAT in YKL-40 regulation. Furthermore, our data suggest a relevant role of glucose metabolism and inflammation on YKL-40 regulation. 2010-12-31T23:00:00Z http://hdl.handle.net/10171/22479 Title: Intraductal papillary mucinous neoplasms (IPMN) of the pancreas: clinico-pathologic results Author(s) : Cienfuegos, J.A. (Javier A.); Rotellar, F. (Fernando); Marti-Cruchaga, P. (Pablo); Valenti, V. (Víctor); Zozaya, G. (Gabriel); Bueno, A. (Álvaro); Pedano, N. (N.); Lozano, M.D. (María Dolores); Sola, J.J. (Jesús J.); Pardo, F. (Fernando) Abstract: Background: intraductal papillary mucinous neoplasm (IPMN) shows a series of lesions which evolve from benign lesions –adenoma– to invasive carcinoma. Aim: to analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference. Material and methods: a retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recommendation. Demographic, diagnostic tools, surgical report, pathologic database and actuarial survival were analyzed with a follow-up from one and a half month through nine years. Results: 6 patients underwent pancreaticoduodenectomies, 4 total pancreatectomies, 2 body or central pancreatectomies, 2 partial pancreatectomies (enucleation) and 1 distal pancreatectomy. A morbidity of 46 and 0% hospital mortality were assessed, with a median length hospital stay of 10 days. In five cases, the IPMN was combined type (both main and branch pancreatic ducts involved) in four main duct-type and branch duct-type in the another six as well. Several atypia (IPMN carcinoma in situ) was observed in 2 patients and invasive carcinoma with negative lymph nodes was identified in 3 patients. A patient without invasive carcinoma died at 66 months of follow-up for pancreas adenocarcinoma. The actuarial survival up to recurrence or death was 105,133 months with a range of follow-up from 1 month and a half until 9 years. Conclusions: IPMN main duct or mixed type warrants complete resection due to its incidence of invasive carcinoma or precursor lesions of malignancy as well. Due to its multifocal pattern, patients should be followed in long-term surveillance. The management of asymptomatic IPMN type branch less than 3 cm is controversial. 2009-12-31T23:00:00Z http://hdl.handle.net/10171/22446 Title: Increased Levels of Calprotectin in Obesity Are Related to Macrophage Content: Impact on Inflammation and Effect of Weight Loss Author(s) : Catalan, V. (Victoria); Gomez-Ambrosi, J. (Javier); Rodriguez, A. (Amaia); Ramirez, B. (Beatriz); Rotellar, F. (Fernando); Valenti, V. (Víctor); Silva, C. (Camilo); Gil, M.J. (María José); Fernandez-Real, J.M. (José Manuel); Salvador, J. (Javier); Frühbeck, G. (Gema) Abstract: Calprotectin has been recently described as a novel marker of obesity. The aim of this study was to determine the circulating concentrations and expression levels of calprotectin subunits (S100A8 and S100A9) in visceral adipose tissue (VAT), exploring its impact on insulin resistance and inflammation and the effect of weight loss. We included 53 subjects in the study. Gene expression levels of the S100A8/A9 complex were analyzed in VAT as well as in both adipocytes and stromovascular fraction cells (SVFCs). In addition, circulating calprotectin and soluble receptor for the advanced glycation end product (sRAGE) concentrations were measured before and after weight loss achieved by Roux-en-Y gastric bypass (RYGB) (n = 26). Circulating concentrations and VAT expression of S100A8/A9 complex were increased in normoglycemic and type 2 diabetic obese patients (P < 0.01) and associated with markers of inflammation (P < 0.01). Oppositely, concentrations of sRAGE were significantly lower (P < 0.001) in both obese groups compared to lean volunteers. Elevated calprotectin levels in obese patients decreased (P < 0.00001) after RYGB, whereas sRAGE concentrations tended to increase. Calprotectin was mainly expressed by SVFCs, and its expression was significantly correlated (P < 0.01) with mRNA levels of the monocyte-macrophage-related molecules macrophage-specific antigen CD68 (CD68), monocyte chemotactic protein 1 (MCP1), integrin alpha-M (CD11B), and NADPH oxidase 2 (NOX2). Tumor necrosis factor-alpha treatment significantly enhanced (P < 0.05) the mRNA levels of S100 calcium-binding protein A8 (S100A8) of human visceral adipocytes. The increased levels of calprotectin in obesity and obesity-associated type 2 diabetes, its positive association with inflammation as well as the higher expression levels in the SVFCs in VAT suggests a potential role of this protein as a chemotactic factor in the recruitment of macrophages to VAT, increasing inflammation and the development of obesity-associated comorbidities. 2010-12-31T23:00:00Z http://hdl.handle.net/10171/22414 Title: Solid pseudopapillary tumor of the pancreas (SPPT). Still an unsolved enigma Author(s) : Cienfuegos, J.A. (Javier A.); Lozano, M.D. (María Dolores); Rotellar, F. (Fernando); Marti, P. (Pablo); Pedano, N.(N.); Arredondo, J. (Jorge); Bellver, M. (M.); Sola, J.J. (Jesús J.); Pardo, F. (Fernando) Abstract: Solid pseudo-papillary tumor (SPPT) is a rare cystic tumor of the pancreas (1-3% of exocrine tumors of the pancreas) which shows an “enigmatic” behavior on the clinical and molecular pattern. A retrospective analysis of the citological studies and resected specimens of pancreatic cystic tumors from May 1996 to February 2010 was carried out. Three cases of SPPT were found, which are the objective of this study. The diagnosis was established upon occasional finding in the abdominal CT, in spite of sizing between 3 and 6 cm of diameter. In the three cases the preoperative diagnosis was confirmed by citology and specific immunohistochemical staining. Cases 2 and 3 showed strong immunoreactivity for Beta-Catenina and E-Cadherina staining. Radical resection (R0) was carried out in the three cases. A young male –21 years of age (case 1)- who had duodenal infiltration and two lymph nodes metastases died of hepatic and peritoneal recurrence 20 months following surgery. The other two cases are free of disease. The current review of the literature reports roughly 800 cases since the first report in 1959, and shows the enigmatic character of this tumor regarding the cellular origin, molecular pathways, prognostic factors and clinical behavior. 2009-12-31T23:00:00Z http://hdl.handle.net/10171/21877 Title: Increased cardiovascular risk markers in obesity are associated with body adiposity: role of leptin Author(s) : Gomez-Ambrosi, J. (Javier); Salvador, J. (Javier); Silva, C. (Camilo); Pastor, C. (Carlos); Rotellar, F. (Fernando); Gil, M.J. (María José); Cienfuegos, J.A. (Javier A.); Frühbeck, G. (Gema) Abstract: Epidemiological studies have shown that obesity is associated with increased blood concentrations of proinflammatory factors and markers of endothelial dysfunction such as fibrinogen, C-reactive protein (CRP), and von Willebrand factor (vWF). We analyzed the association of these markers with percentage of body fat (BF), and the influence of leptin in a cross-sectional study of 1,089 subjects (366 men) aged 44 (34-53) [median (interquartile range)] years, who were classified as obese or nonobese according to BF estimated by whole-body air displacement plethysmography. Obesity was defined as BF >or= 25% in men and >or= 35% in women. Compared with non-obese subjects (mean +/- SD), obese patients had higher concentrations of fibrinogen (312 +/- 78 vs. 342 +/- 81 mg/dl, P < 0.001), CRP (0.41 +/- 0.75 vs. 0.75 +/- 1.04 mg/l, P = 0.014), vWF (107 +/- 29 vs. 123 +/- 55%, P < 0.001), and leptin (10.4 +/- 6.5 vs. 37.5 +/- 26.1 ng/ml, P < 0.0001). A positive correlation was observed between BF and fibrinogen (r = 0.266; P < 0.0001), logCRP (r = 0.409; P < 0.0001), and vWF (r = 206; P < 0.0001). Leptin was correlated with fibrinogen (r = 0.219, P < 0.0001), logCRP (r = 0., P < 0.0001), and vWF (r = 0.124, P = 0.002), but the statistical significance was lost after including BF in adjusted-correlation and multivariate analysis, suggesting that they are not regulated by leptin per se. In conclusion, the obesity-associated increase in the circulating concentrations of fibrinogen, CRP, and vWF is highly associated to BF and apparently not determined by leptin 2005-12-31T23:00:00Z