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Coloproctología Immunohistochemical expression and microsatellite instability in Lynch syndrome. Founder and recurrent CDH1 mutations in families with hereditary diffuse gastric cancer. Germ line mutations of mismatch repair genes in hereditary nonpolyposis colorectal cancer patients with small bowel cancer: International Society for Gastrointestinal Hereditary Tumours Collaborative Study. Prognostic value of E-cadherin, beta-catenin, MMPs (7 and 9), and TIMPs (1 and 2) in patients with colorectal carcinoma. The prevalence of MADH4 and BMPR1A mutations in juvenile polyposis and absence of BMPR2, BMPR1B, and ACVR1 mutations. Colorectal cancer staging: reappraisal of N/PN classification. Pathogenicity of the hereditary colorectal cancer mutation hMLH1 del616 linked to shortage of the functional protein. Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes. Rectal cancer: local recurrence after surgery without radiotherapy. Pudendal neuropathy is not related to physiologic pelvic outlet obstruction. Electrodiagnostic evaluation of fecal incontinence. Pudendal neuropathy in evacuatory disorders. Role of pudendal nerve terminal motor latency assessment in constipated patients. Single-dose oral ciprofloxacin plus parenteral metronidazole for perioperative antibiotic prophylaxis in colorectal surgery. Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome) in Argentina: Report from a Referral Hospital Register. Hereditary diffuse gastric cancer (HDGC): presentation of a family with a new mutation of the CDH1 gene][Article in Spanish Hereditary nonpolyposis colorectal cancer (lynch syndrome) in Argentina: report from a referral hospital register. Cirugía de Higado - Vías Biliares y Páncreas Short-Term and Long-Term Outcomes After Simultaneous Resection of Colorectal Malignancies and Synchronous Liver Metastases. Liver metastasis resection: a simple technique that makes it easier. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. Antimicrobial therapy for acute cholangitis: Tokyo Guidelines. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. Techniques of biliary drainage for acute cholangitis: Tokyo Guidelines. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo Guidelines. Bile duct injuries: management of late complications. Transmission of T. cruzi infection via liver transplantation to a nonreactive recipient for Chagas' disease. Percutaneous management of benign pathology of the main biliary tract: experience in a section of pancreatic and hepatobiliary surgery Hepatic tuberculoma: presentation of cases and review of the literature Complications of hepatic resection surgery: a 12-month experience in a high case-load specialized center Catastrophic antiphospholipid syndrome complicating orthotopic liver transplantation. Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes. Multimodal treatment of hepatocellular carcinoma Nitric oxide synthase activity in the splanchnic vasculature of patients with cirrhosis: relationship with hemodynamic disturbances. Partial left lateral segment transplant from a living donor. Liver transplantation as treatment for arterioportal fistulae. Splanchnic hyperemia after liver transplantation in patients with end-stage liver disease. Renal failure in patients with liver transplant: incidence and predisposing factors. Extracorporeal auxiliary xenoperfusion: animal model of support in fulminant liver failure. Current therapeutic approach to acute acalculous cholecystitis Total pancreaticoduodenal homotransplantation in dogs immunosuppressed with cyclosporine and steroids. Successful small bowel allotransplantation in dogs with cyclosporine and prednisone. Liver transplantation: current status Libros Argentinos publicados Transplante Renopancreático, Celular y Medicina Regenerativa Reconsolidation of declarative memory in humans. Medicine and research: an indissoluble relationship. Differential expression of glycans in the hippocampus of rats trained on an inhibitory learning paradigm.
Coloproctología 1: Medicina (B Aires). 2007;67(3):274-8. Immunohistochemical expression and microsatellite instability in Lynch syndrome Vaccaro CA, Carrozzo JE, Mocetti E, Berho M, Valdemoros P, Mullen E, Oviedo M, Redal MA.
Sección de Coloproctología, Hospital Italiano de Buenos Aires, Argentina.
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Mutation of the mismatch repair genes MLH1 and MSH2 account for the majority of the genetic abnormalities in Lynch syndrome. Immunohistochemical detection of their protein products is becoming an increasingly common method to detect these mutations. The aim of this study was to compare the expression of MLH1 and MSH2 by immunohistochemistry and its relationship with a group of clinical and histological variables in patients with known Lynch syndrome (n=16) and in cohort of young patients (less than 50 years) who did not meet Amsterdam criteria (n=25). The mean age was 40.7 and 64% were women. Conclusive results were obtained in 40 cases (97.6%). Eighteen cases (45%) showed abnormal expression of either MLH1 (11 cases) or MSH2 (6 cases) and both stains (1 case). Alteration of the normal staining pattern was seen more commonly in patients with Lynch syndrome than in the sporadic group (68.7% vs 28%, p=0.01). A significant correlation was obtained between abnormal protein expression and microsatellite instability (MSI): normal expression: 5.9%, lack of expression: 92.3%, p<0.0001. The sensitivity and specificity of the immunohistochemical to predict MSI were 92.3% and 94.1% respectively. Immunohistochemistry and MSI results did not correlate with any histopathological parameter. In conclusion, in our experience abnormal staining of MLH and MSH correlates strongly with the presence of MSI. In addition it appears that in our population a significant proportion of young patients (< 50 years old) demonstrate alterations in the mismatch repair gene products suggesting an important role of these molecules in tumorigenesis. Publication Types: English Abstract PMID: 17628916 [PubMed - in process] Volver Arriba
2: JAMA. 2007 Jun 6;297(21):2360-72. Epub 2007 Jun 3.
Comment in:
JAMA. 2007 Jun 6;297(21):2410-1. Founder and recurrent CDH1 mutations in families with hereditary diffuse gastric cancer. Kaurah P, MacMillan A, Boyd N, Senz J, De Luca A, Chun N, Suriano G, Zaor S, Van Manen L, Gilpin C, Nikkel S, Connolly-Wilson M, Weissman S, Rubinstein WS, Sebold C, Greenstein R, Stroop J, Yim D, Panzini B, McKinnon W, Greenblatt M, Wirtzfeld D, Fontaine D, Coit D, Yoon S, Chung D, Lauwers G, Pizzuti A, Vaccaro C, Redal MA, Oliveira C, Tischkowitz M, Olschwang S, Gallinger S, Lynch H, Green J, Ford J, Pharoah P, Fernandez B, Huntsman D. Hereditary Cancer Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. CONTEXT: Hereditary diffuse gastric cancer is caused by germline mutations in the epithelial cadherin (CDH1) gene and is characterized by an increased risk for diffuse gastric cancer and lobular breast cancer. OBJECTIVE: To determine whether recurring germline CDH1 mutations occurred due to independent mutational events or common ancestry. DESIGN, SETTING, AND PATIENTS: Thirty-eight families diagnosed clinically with hereditary diffuse gastric cancer were accrued between November 2004 and January 2006 and were analyzed for CDH1 mutations as part of an ongoing study at the British Columbia Cancer Agency. Twenty-six families had at least 2 gastric cancer cases with 1 case of diffuse gastric cancer in a person younger than 50 years; 12 families had either a single case of diffuse gastric cancer diagnosed in a person younger than 35 years or multiple cases of diffuse gastric cancer diagnosed in persons older than 50 years. MAIN OUTCOME MEASURES: Classification of family members as carriers or noncarriers of CDH1 mutations. Haplotype analysis to assess recurring mutations for common ancestry was performed on 7 families from this study and 7 previously reported families with the same mutations. RESULTS: Thirteen mutations (6 novel) were identified in 15 of the 38 families (40% detection rate). The 1137G>A splicing mutation and the 1901C>T (A634V) missense/splicing mutation occurred on common haplotypes in 2 families but on different haplotypes in a third family. The 2195G>A (R732Q) missense/splicing mutation occurred in 2 families on different haplotypes. The 2064-2065delTG mutation occurred on a common haplotype in 2 families. Two families from this study plus 2 additional families carrying the novel 2398delC mutation shared a common haplotype, suggesting a founder effect. All 4 families originate from the southeast coast of Newfoundland. Due to concentrations of lobular breast cancer cases, 2 branches of this family had been diagnosed as having hereditary breast cancer and were tested for BRCA mutations. Within these 4 families, the cumulative risk by age 75 years in mutation carriers for clinically detected gastric cancer was 40% (95% confidence interval [CI], 12%-91%) for males and 63% (95% CI, 19%-99%) for females and the risk for breast cancer in female mutation carriers was 52% (95% CI, 29%-94%). CONCLUSIONS: Recurrent CDH1 mutations in families with hereditary diffuse gastric cancer are due to both independent mutational events and common ancestry. The presence of a founder mutation from Newfoundland is strongly supported. Publication Types: Research Support, N.I.H., Extramural. Research Support, Non-U.S. Gov't PMID: 17545690 [PubMed - indexed for MEDLINE] Volver Arriba
3: Clin Cancer Res. 2006 Jun 1;12(11 Pt 1):3389-93. Germ line mutations of mismatch repair genes in hereditary nonpolyposis colorectal cancer patients with small bowel cancer: International Society for Gastrointestinal Hereditary Tumours Collaborative Study. Park JG, Kim DW, Hong CW, Nam BH, Shin YK, Hong SH, Kim IJ, Lim SB, Aronson M, Bisgaard ML, Brown GJ, Burn J, Chow E, Conrad P, Douglas F, Dunlop M, Ford J, Greenblatt MS, Heikki J, Heinimann K, Lynch EL, Macrae F, McKinnon WC, Möeslein G, Rossi BM, Rozen P, Schofield L, Vaccaro C, Vasen H, Velthuizen M, Viel A, Wijnen J; International Society for Gastrointestinal Hereditary Tumours. Korean Hereditary Tumor Registry, Laboratory of Cell Biology, Cancer Research Institute and Cancer Research Center, Seoul National University College of Medicine, Korea.
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PURPOSE: The aim of study was to determine the clinical characteristics and mutational profiles of the mismatch repair genes in hereditary nonpolyposis colorectal cancer (HNPCC) patients with small bowel cancer (SBC). EXPERIMENTAL DESIGN: A questionnaire was mailed to 55 members of the International Society for Gastrointestinal Hereditary Tumours, requesting information regarding patients with HNPCC-associated SBC and germ line mismatch repair gene mutations. RESULTS: The study population consisted of 85 HNPCC patients with identified mismatch repair gene mutations and SBCs. SBC was the first HNPCC-associated malignancy in 14 of 41 (34.1%) patients for whom a personal history of HNPCC-associated cancers was available. The study population harbored 69 different germ line mismatch repair gene mutations, including 31 mutations in MLH1, 34 in MSH2, 3 in MSH6, and 1 in PMS2. We compared the distribution of the mismatch repair mutations in our study population with that in a control group, including all pathogenic mismatch repair mutations of the International Society for Gastrointestinal Hereditary Tumours database (excluding those in our study population). In patients with MSH2 mutations, patients with HNPCC-associated SBCs had fewer mutations in the MutL homologue interaction domain (2.9% versus 19.9%, P = 0.019) but an increased frequency of mutations in codons 626 to 733, a domain that has not previously been associated with a known function, versus the control group (26.5% versus 2.8%, P < 0.001). CONCLUSIONS: In HNPCC patients, SBC can be the first and only cancer and may develop as soon as the early teens. The distribution of MSH2 mutations found in patients with HNPCC-associated SBCs significantly differed from that found in the control group (P < 0.001). PMID: 16740762 [PubMed - in process] Volver Arriba
4: J Surg Oncol. 2006 Feb 1;93(2):151-60. Related Articles, Substance (MeSH Keyword), LinkOut
Prognostic value of E-cadherin, beta-catenin, MMPs (7 and 9), and TIMPs (1 and 2) in patients with colorectal carcinoma.
Roca F, Mauro LV, Morandi A, Bonadeo F, Vaccaro C, Quintana GO, Specterman S, de Kier Joffé EB, Pallotta MG, Puricelli LI, Lastiri J. Research Area of the Institute of Oncology Angel H. Roffo, Buenos Aires, Argentina. BACKGROUND AND OBJECTIVES: Therapy of colorectal tumors (CRC) based on histology and clinical factors is insufficient to predict the evolution of each patient. The finding of molecular abnormalities able to differentiate subgroups of patients with bad prognosis will improve our ability to treat them successfully. Our purpose was to analyze retrospectively the prognostic input of E-cadherin, beta-catenin, metalloproteinases (MMPs) (7 and 9), and tissue inhibitors of metalloproteinases (TIMPs) (1 and 2) in patients with a follow-up period of 5 years. METHODS: Antigen expression was analyzed by immunohistochemistry. Prognostic evaluation was performed with the multivariate proportional hazards model. RESULTS: We demonstrated a concomitant loss of E-cadherin and beta-catenin at membranous level and an abnormal accumulation of nuclear beta-catenin. Besides, we found that all MMPs and TIMPs studied were overexpressed in CRC tissue. There was no association between the expression of any of these molecules and the known clinical-pathological parameters employed in CRC pathology. A multivariate analysis demonstrated that the overall survival could be independently predicted by the loss of E-cadherin and the overexpression of TIMP-2. CONCLUSIONS: The expression of E-cadherin and TIMP-2 could be relevant in determining the prognosis of CRC patients and providing a more accurate mechanism for their classification. (c) 2006 Wiley-Liss, Inc. Publication Types:
Research Support, Non-U.S. Gov't PMID: 16425303 [PubMed - indexed for MEDLINE] Volver Arriba
5: J Med Genet. 2004 Jul;41(7):484-91. Related Articles, OMIM (calculated), OMIM (cited), Substance (MeSH Keyword), Cited in PMC, Cited in Books, LinkOut
The prevalence of MADH4 and BMPR1A mutations in juvenile polyposis and absence of BMPR2, BMPR1B, and ACVR1 mutations.
Howe JR, Sayed MG, Ahmed AF, Ringold J, Larsen-Haidle J, Merg A, Mitros FA, Vaccaro CA, Petersen GM, Giardiello FM, Tinley ST, Aaltonen LA, Lynch HT. Department of Surgery, University of Iowa College of Medicine, Iowa City, IA 52242-1086, USA.
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BACKGROUND: Juvenile polyposis (JP) is an autosomal dominant syndrome predisposing to colorectal and gastric cancer. We have identified mutations in two genes causing JP, MADH4 and bone morphogenetic protein receptor 1A (BMPR1A): both are involved in bone morphogenetic protein (BMP) mediated signalling and are members of the TGF-beta superfamily. This study determined the prevalence of mutations in MADH4 and BMPR1A, as well as three other BMP/activin pathway candidate genes in a large number of JP patients. METHODS: DNA was extracted from the blood of JP patients and used for PCR amplification of each exon of these five genes, using primers flanking each intron-exon boundary. Mutations were determined by comparison to wild type sequences using sequence analysis software. A total of 77 JP cases were sequenced for mutations in the MADH4, BMPR1A, BMPR1B, BMPR2, and/or ACVR1 (activin A receptor) genes. The latter three genes were analysed when MADH4 and BMPR1A sequencing found no mutations. RESULTS: Germline MADH4 mutations were found in 14 cases (18.2%) and BMPR1A mutations in 16 cases (20.8%). No mutations were found in BMPR1B, BMPR2, or ACVR1 in 32 MADH4 and BMPR1A mutation negative cases. DISCUSSION: In the largest series of JP patients reported to date, the prevalence of germline MADH4 and BMPR1A mutations is approximately 20% for each gene. Since mutations were not found in more than half the JP patients, either additional genes predisposing to JP remain to be discovered, or alternate means of inactivation of the two known genes are responsible for these JP cases. Publication Types:
Multicenter Study
Research Support, Non-U.S. Gov't PMID: 15235019 [PubMed - indexed for MEDLINE] Volver Arriba
6: Dis Colon Rectum. 2004 Jan;47(1):66-9. Epub 2004 Jan 14. Related Articles, LinkOut
Colorectal cancer staging: reappraisal of N/PN classification.
Vaccaro CA, Bonadeo FA, Benati ML, Quintana GM, Rubinstein F, Mullen E, Telenta M, Lastiri JM. Department of General Surgery, General Surgery Service, pision of Colorectal Surgery, Hospital Italiano de Buenos Aires, Argentina.
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PURPOSE: Current American Joint Committee on Cancer and the Union Internationale Contre le Cancer TNM classification disregards location of positive nodes, discontinuing N3 category, which constitutes a major modification to 1987 version. This study was designed to assess the impact of the recategorization of former N3 cases and the reliability of the current N1-N2 subcategorization of Stage III patients. METHODS: Prospectively collected data from 1,391 patients (55.8 percent males; median age, 64 (range, 21-97) years), operated on with curative intent between 1980 and 1999, were analyzed. The median follow-up was 60 (interquartile range, 27-97) months with 129 cases lost to follow-up. RESULTS: Of positive node cases, 25.3 percent were former N3. Among them, 30.5 percent migrated to the N1 group and 69.5 percent to the N2 group. The proportions of former N3 cases in N1 and N2 groups were 12.5 percent and 46.1 percent, respectively (P<0.001). Node-positive patients had an actuarial five-year survival rate of 56.7 percent (95 percent confidence interval, 53-59), with a significant difference between N1/N2 categories (63.6 vs. 44.1 percent, respectively; P<0.001). Although apical node involvement and more than three positive nodes were associated with poorer outcomes in univariate analysis, only the number of positive nodes had independent association (hazard ratio, 1.6 (range, 1.2-2.2); P<0.001). Integration of former N3 cases did not modify outcomes. CONCLUSIONS: The recategorization of former N3 involved a high proportion of positive node cases. Current N1/N2 categories clearly defined different outcomes and were not modified by the integration of former N3. Publication Types:
Evaluation Studies PMID: 14719153 [PubMed - indexed for MEDLINE] Volver Arriba
7: Gastroenterology. 2003 Aug;125(2):501-9. Related Articles, Substance (MeSH Keyword), LinkOut Pathogenicity of the hereditary colorectal cancer mutation hMLH1 del616 linked to shortage of the functional protein. Raevaara TE, Vaccaro C, Abdel-Rahman WM, Mocetti E, Bala S, Lönnqvist KE, Kariola R, Lynch HT, Peltomäki P, Nyström-Lahti M. pision of Genetics, Department of Biosciences, University of Helsinki, Helsinki, Finland. BACKGROUND & AIMS: Hereditary nonpolyposis colorectal cancer is associated with mismatch repair deficiency. Most predisposing mutations prevent the production of functional mismatch repair protein. Thus, when the wild-type copy is also inactivated, the cell becomes mismatch repair deficient, and this leads to a high degree of microsatellite instability in tumors. However, tumors linked to nontruncating mutations may display positive or partly positive immunohistochemical staining of the mutated protein and low or atypical microsatellite instability status, which suggests impaired functional activity but not a total lack of mismatch repair. We found human mutL homology (hMLH) 1 del616, one of the most widespread recurring mutations in hereditary nonpolyposis colorectal cancer, segregating in a large hereditary nonpolyposis colorectal cancer family. Because the predicted coding change is a deletion of only 1 amino acid, the pathogenicity of the mutation was evaluated. METHODS: Many analyses were performed to assess the pathogenicity of hMLH1 del616 and to study the expression and function of the mutated messenger RNA and protein. RESULTS: Genetic and immunohistochemical evidence supported hMLH1-linked cancer predisposition in this family. Microsatellite instability varied from low to high, and the hMLH1 protein was lost in 2 tumors but was partly detectable in 1 tumor. Whereas similar optimal amounts of mutated hMLH1 del616 and wild-type hMLH1 proteins were equally functional in an in vitro mismatch repair assay, the amount of in vivo-expressed hMLH1 del616 was much lower than the amount of wild-type protein; this suggests that the deletion imparts instability to the mutant protein. CONCLUSIONS: Our results suggest that the pathogenicity of hMLH1 del616 is not linked to nonfunctionality, but to shortage of the functional protein. Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S. PMID: 12891553 [PubMed - indexed for MEDLINE] Volver Arriba
8: J Am Coll Surg. 2002 Aug;195(2):196-202. Related Articles, LinkOut
Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes.
de Santibañes E, Lassalle FB, McCormack L, Pekolj J, Quintana GO, Vaccaro C, Benati M. Hepato Pancreatic Biliary and Liver Transplantation Section, Department of General Surgery, Hospital Italiano, Buenos Aires, Argentina. BACKGROUND: Our goal was to analyze the results of resection of colorectal cancer and liver metastases in one procedure. STUDY DESIGN: Between June 1982 and July 1998, 522 patients underwent liver resection for colorectal metastases. Liver resection was performed simultaneously with colorectal resection in 71 cases, representing the population in this study. Morbidity, mortality, overall survival, and disease-free survival times were analyzed. Median followup time was 29 months (range 6 to 162 months). Prognostic factors and their influence on outcomes were analyzed. RESULTS: The median hospital stay was 8 days (range 5 to 23 days). Morbidity was 21% and included nine pleural effusions, seven wound abscesses, four instances of hepatic failure, three systemic infections, three intraabdominal abscesses, and one colonic anastomosis leakage. Operative mortality was 0%. Recurrence rate was 57.7% (41 or 71), and progression of disease was detected in 33.8%. Overall and disease-free survivals at 1, 3, and 5 years were 88%, 45%, and 38% and 67%, 17%, and 9%, respectively. Prognostic factors with notable influence on patient outcomes were nodal stage as per TNM classification, number of liver metastases, diameter (smaller or larger than 5 cm), liver resection specimen weight (lighter or heavier than 90 g), and liver resection margin (smaller or larger than 1 cm). CONCLUSIONS: Simultaneous resection of colorectal cancer and liver metastases can be performed with low morbidity and mortality rates, avoiding a second surgical procedure. PMID: 12168966 [PubMed - indexed for MEDLINE] Volver Arriba
9: Dis Colon Rectum. 2001 Mar;44(3):374-9. Related Articles, LinkOut Rectal cancer: local recurrence after surgery without radiotherapy. Bonadeo FA, Vaccaro CA, Benati ML, Quintana GM, Garione XE, Telenta MT. Department of Surgery, Hospital Italiano, Buenos Aires, Argentina. PURPOSE: This study was designed to assess the local recurrence rate and prognostic factors for local recurrence in patients undergoing curative anterior or abdominoperineal resections without radiotherapy. METHODS: From January 1980 to December 1996, 514 consecutive patients underwent curative resections for rectal cancer. We excluded those with preoperative radiotherapy (n = 23), postoperative radiotherapy (n = 27), local resection (n = 36), and 11 (2.1 percent) patients who died postoperatively. The remaining 417 patients (249 males) with a median age of 64 (range, 21-90) years were analyzed. For upper third lesions, mesorectal tissue was excised down to at least 5 cm below the tumor. Total mesorectal excision was performed for lower and middle tumors. Postoperative chemotherapy was limited to patients with Stage III lesions. Median follow-up (and 95 percent confidence interval) was (5.2 4.3-5.9) years, with 87.7 percent of patients followed up longer than 24 months. Local recurrence was defined as any recurrence within the field of resection, regardless of the presence or absence of distant metastasis. RESULTS: Five-year local recurrence rate(and 95 percent confidence interval) was 9.7 (6.4-13) percent, with a median time to diagnosis of 15 (10-23) months. Local recurrence rates in Stages I, II, and III were: 3.1, 4.1, and 24.1 percent, respectively (P < 0.0001). In relation to node status, local recurrence rates were N0, 4.1 (1.7-6.5) percent; N1, 12.6 (4.6-20.6) percent; N2, 32.1 (12.1-52.1) percent; and N3, 59.3 (22.5-96.1) percent; (P < 0.00001). Lower third tumors had a higher local recurrence rate than middle and upper third tumors: 17.9, 7.1, and 5.1 percent, respectively (P = 0.002). Adjusted by stage, this difference was maintained only in Stage III tumors. Among lower tumors, those at 6 and 7 cm from the anal verge had a lower local recurrence rate than those below 6 cm (6.7 vs. 26.2 percent, respectively; P = 0.02). Accidental rectal perforation at or near the tumor site occurred in 12 cases (2.9 percent), showing a strong correlation with local recurrence (P < 0.0001). Multivariate analysis showed significant higher risk for lower third tumors (hazard ratio, 2.98) and positive nodes (hazard ratio, 4.78). CONCLUSIONS: Appropriate surgery without irradiation achieves excellent local control in N0 rectal cancers. Node metastasis, lower third localization (especially below 6 cm), and accidental rectal perforation at or near the tumor site are significantly associated with a higher local recurrence rate. Publication Types:
Comparative Study PMID: 11289283 [PubMed - indexed for MEDLINE] Volver Arriba
10: Dis Colon Rectum. 1995 Jun;38(6):630-4. Related Articles, LinkOut Pudendal neuropathy is not related to physiologic pelvic outlet obstruction. Vaccaro CA, Wexner SD, Teoh TA, Choi SK, Cheong DM, Salanga VD. Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida 33309, USA. Chronic straining because of pelvic outlet obstruction is hypothesized to cause pudendal neuropathy (PN) by stretch injury. PURPOSE: The aim of this study was to determine any association between PN and pelvic outlet obstruction. METHODS: One hundred forty-seven constipated patients were evaluated by cinedefecography and pudendal nerve terminal motor latency assessment. PN was defined as a latency longer than 2.2 ms. Pelvic outlet obstructive patterns of evacuation included paradoxic contraction, nonrelaxation of the puborectalis muscle, or failure of opening of the anal canal. RESULTS: Median length of constipation including straining during evacuation was eight (range, 1-47) years. Ninety-one (62 percent) subjects had a normal pattern of evacuation, and 56 (38 percent) had an obstructed pattern. Both groups had a similar median age (68 vs. 69 years, respectively; P > 0.05) and same median length of symptoms. Overall incidence of PN was 23.8 percent (10.9 percent unilateral and 12.9 percent bilateral). There was no difference in the incidence of PN between patients with normal evacuation and patients with obstructed evacuation (24.2 percent vs. 23.2 percent, respectively; P > 0.05). Patients with PN had a similar incidence of physiologic pelvic outlet obstruction as did patients without PN. However, median age of patients with PN was higher than those without PN (73 vs. 66 years, respectively; P > 0.05). CONCLUSION: There was a difference in the incidence of PN between normal and obstructed patterns of evacuation. Therefore, the espoused theory that obstructed defecation causes PN appears flawed. Publication Types:
Research Support, Non-U.S. Gov't PMID: 7774476 [PubMed - indexed for MEDLINE] Volver Arriba
11: Muscle Nerve. 1995 Jun;18(6):612-9. Related Articles, LinkOut Erratum in:
Muscle Nerve 1995 Nov;18(11):1368. Electrodiagnostic evaluation of fecal incontinence. Cheong DM, Vaccaro CA, Salanga VD, Wexner SD, Phillips RC, Hanson MR, Waxner SD. Department of Neurology, Cleveland Clinic Florida, Fort Lauderdale, 33309, USA. The aim of this study was to assess the utility of electrodiagnostic testing (EDT) for the evaluation of fecal incontinence (FI). Over a 5-year period, 225 patients (174 females) with FI were prospectively studied with anal manometry, anal ultrasonography, anal electromyography (AEMG), and pudendal nerve terminal motor latency (PNTML) assessment. The mean age was 60 (range 12-94) years. Causes of FI identified by clinical evaluation were obstetric injuries (45), rectal prolapse (43), iatrogenic or other trauma (42), neurologic disease (23), and idiopathic (72). EDT revealed abnormalities in 76% of patients. The incidence of pudendal neuropathy (PN) was 36% (bilateral 21%, unilateral 15%). Patients with PN were older than were those with normal PNTML (mean 71 vs. 63 years; P < 0.002). No relationship between squeeze pressure and PN could be demonstrated (P = 0.9). Reduced motor unit potential (MUP) recruitment on AEMG was present in 60% and was associated with decreased squeeze pressure (P < 0.001) and increased MUP polyphasia (P < 0.001). Concurrence of AEMG and anal ultrasonographic findings was observed in 35 of 41 patients (84%). Defects were overlooked in one study but identified by the other on three occasions, each. Moreover, 8 of 22 patients with demonstrated sphincter defects had unsuspected PN or extensive sphincter injury on AEMG that precluded sphincter repair. In conclusion, EDT proved to be a valuable tool in the evaluation and subsequent treatment of patients with FI. Publication Types:
Research Support, Non-U.S. Gov't PMID: 7753124 [PubMed - indexed for MEDLINE] Volver Arriba
12: Dis Colon Rectum. 1995 Feb;38(2):166-71. Related Articles, LinkOut Pudendal neuropathy in evacuatory disorders. Vaccaro CA, Cheong DM, Wexner SD, Nogueras JJ, Salanga VD, Hanson MR, Phillips RC. Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale. PURPOSE: Aims of the present study were to assess frequency of pudendal neuropathy in patients with constipation and fecal incontinence, to determine its correlation with clinical variables, anal electromyographic assessment, and anal manometric pressures, and to determine usefulness of the pudendal nerve terminal motor latency assessment in evaluation of these evacuatory disorders. METHODS: From 1988 to 1993, 395 patients (constipated, 172; incontinent, 223) underwent pudendal nerve terminal motor latency, electromyography, and anal manometry. Pudendal neuropathy was defined as a pudendal nerve terminal motor latency greater than 2.2 ms. RESULTS: Patients were a mean age of 60.7 (range, 17-88) years. Overall incidence of pudendal neuropathy was 31.4 percent (constipated, 23.8 percent; incontinent, 37.2 percent; P < 0.05). Incidence of pudendal neuropathy dramatically increased after 70 years of age in both groups (22 percent vs. 44 percent; P < 0.05). Moreover, subjects with pudendal neuropathy were older than those without pudendal neuropathy (mean age, 67 vs. 57 years; P < 0.05). The presence of pudendal neuropathy was associated with decreased motor unit potentials recruitment in patients with incontinence (P < 0.01). Patients with and without pudendal neuropathy had a similar mean squeezing pressure in both groups. CONCLUSION: Pudendal neuropathy is an age-related phenomenon. Although pudendal neuropathy is associated with abnormal anal electromyographic findings in patients with incontinence, no association with anal manometric pressures was found. Pudendal nerve terminal motor latency assessment is a useful tool in the evaluation of patients with fecal incontinence, but its role in the assessment of constipated patients remains unknown. PMID: 7851171 [PubMed - indexed for MEDLINE] Volver Arriba
13: Dis Colon Rectum. 1994 Dec;37(12):1250-4. Related Articles, LinkOut Role of pudendal nerve terminal motor latency assessment in constipated patients. Vaccaro CA, Cheong DM, Wexner SD, Salanga VD, Phillips RC, Hanson MR. Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale. The importance of pudendal nerve terminal motor latency assessment for the evaluation of incontinence is well established. However, its role in constipated patients remains unclear. PURPOSE: The purpose of the present study was to assess the incidence of pudendal neuropathy in constipated patients and its correlation with others variables including age, sex, anal pressures, and anal electromyography. RESULTS: From 1988 to 1993, 161 patients with chronic constipation underwent pudendal nerve terminal motor latency assessment, anal electromyography, and anal manometry. The overall incidence of pudendal neuropathy was 23.6 percent; females and males had a similar incidence (24 percent vs. 23 percent, respectively; P > 0.05). Patients over 70 years old had a significantly higher incidence of pudendal neuropathy than did patients under 70 years (37 percent vs. 12 percent, respectively; P < 0.01). Patients with paradoxical puborectalis contraction on anal electromyographic assessment had a higher incidence of bilateral neuropathy, paradoxical puborectalis contraction (+)23 percent vs. paradoxical puborectalis contraction (-)8 percent, P < 0.05. Patients with pudendal neuropathy also had a higher incidence of decreased motor units potential recruitment than did patients without pudendal neuropathy (31.5 percent vs. 17 percent, respectively; P > 0.05). CONCLUSIONS: Pudendal nerve terminal motor latency assessment was able to detect unsuspected pudendal neuropathy in 24 percent of patients. This finding correlated with age and with the presence of paradoxical puborectalis contraction but not with manometric anal pressures, motor unit potentials recruitment, or the presence of polyphasia. However, the often espoused relationship between pudendal latency and external sphincter function could not be demonstrated. PMID: 7995153 [PubMed - indexed for MEDLINE] Volver Arriba
14: Chemotherapy. 1993 May-Jun;39(3):218-24. Related Articles, Compound (MeSH Keyword), Substance (MeSH Keyword), LinkOut Single-dose oral ciprofloxacin plus parenteral metronidazole for perioperative antibiotic prophylaxis in colorectal surgery. Rohwedder R, Bonadeo F, Benati M, Ojea Quintana G, Schlecker H, Vaccaro C. Hospital Italiano, Buenos Aires, Argentina. From 1983 until 1990 our standard antibiotic prophylaxis in colorectal surgery has been 80 mg gentamicin plus 500 mg metronidazole, both administered intravenously at the beginning of anesthesia, and then 80 mg gentamicin every 8 h for 3 days. In this time period, 718 patients undergoing elective colorectal surgery by abdominal approach were treated with this prophylactic procedure. The mean wound infection rate was 13.4% with no significant differences between years. In the present study, including 100 adult patients, intravenous gentamicin has been replaced by a single oral dose of 750 mg ciprofloxacin randomly administered 1, 2 or 3 h (+/- 30 min) before anesthesia. All other procedures remained unchanged including intravenous metronidazole. In order to correlate an eventual infection with the actual tissue concentrations during surgery, samples of colon, peritoneum, muscle, subcutaneous fat and skin were obtained from all patients and assayed by HPLC. In only 3 cases (3% of them casuistic) was a wound infection observed, 2 of minor importance and 1 case with wound dehiscence. This infection rate is significantly lower than 13.4% obtained with our previous standard regimen, and lower than the 9% wound infection rate considered to be the 'gold standard' for elective colon resections. The effective ciprofloxacin concentrations in tissues were usually notably higher than the MICs of the pathogens commonly observed in surgical infections of colorectal surgery. By far the highest ciprofloxacin concentrations were observed in colon tissue which may explain the absence of anastomotic dehiscence or peritoneal sepsis in our series.(ABSTRACT TRUNCATED AT 250 WORDS) Publication Types:
Clinical Trial
Comparative Study
Randomized Controlled Trial PMID: 8508692 [PubMed - indexed for MEDLINE] Volver Arriba
15: Dis Colon Rectum. 2007 Sep 11; [Epub ahead of print] Related Articles, LinkOut Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome) in Argentina: Report from a Referral Hospital Register. Vaccaro CA, Bonadeo F, Roverano AV, Peltomaki P, Bala S, Renkonen E, Redal MA, Mocetti E, Mullen E, Ojea-Quintana G, Benati ML, Rivello HG, Clark MB, Lynch JF, Lynch HT. Department of Colorectal Surgery, Hospital Italiano de Buenos Aires, Guayaquil 226, 7B (1424) Capital Federal, Buenos Aires, Argentina,
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. PURPOSE: The first Argentine experience with epidemiologic, molecular, and genetic counseling data is reported. METHODS: We analyzed 43 families fulfilling Amsterdam criteria identified from a prospective database with data from 779 relatives. RESULTS: Eleven families (25.6 percent) presented as Lynch I, 29 (67.4 percent) as Lynch II, and 3 (7 percent) as Muir-Torre syndrome. Among the 306 affected members, 197 cases of colorectal cancer were identified (mean age at diagnosis, 52.1 (range, 21-90) years). The most frequent extracolonic tumors were gastric adenocarcinoma in males and endometrium adenocarcinoma in females. A high incidence of breast cancer was observed (16 cases among 155 females, crude rate: 11,594.20/100,000). Twenty-seven patients (8.8 percent) developed more than one tumor. These patients were younger than those with only one tumor (45 vs. 51 years; P = 0.001). In 5 of 11 patients who underwent molecular sequencing, a pathologic mutation was found. A novel C deletion at 1910 nucleotide, codon 637, exon 12 of MSH2 gene was identified in a family with a strong aggregation of breast cancer with lack of MSH2 immunohistochemical staining. For 78.2 percent of counseled inpiduals, this session represented the first time they received information, and 73.9 percent stated that their physicians were unaware of their family background. CONCLUSIONS: Argentine families presented a high incidence of stomach cancer. The elevated incidence of breast cancer and its association with a novel hMSH2 mutation bring to consideration the inclusion of this malignancy as part of the syndrome. A lack of awareness by both physicians and persons at risk was observed. PMID: 17846840 [PubMed - as supplied by publisher] Volver Arriba
16: Hereditary diffuse gastric cancer (HDGC): presentation of a family with a new mutation of the CDH1 gene][Article in Spanish Van Domselaar F, Correa D, Vaccaro C, Redal M, Van Domselaar R, Huntsman D, Kaurah P, Senz J, Lynch H.
Servicio de Gastroenterología del Hospital Italiano, Cudad Autónoma, Bs As, Argentina.
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INTRODUCTION: HDGC is a hereditary cancer syndrome with an autosomic dominant pattern. It may be clinically diagnosed by family background, and confirmed by genetic testing. In 40% of the families, a mutation in the CDH1 gene (E-cadherin) can be identified. Furthermore, the identification of the pathogenic mutation enables the segregate non-carriers (having population risk) and carriers. Prevention for the latter group includes prophylactic gastrectomy or surveillance endoscopy every 6 to 12 months. OBJECTIVE: to present the case of an HDGC family with identified CDH1 mutation. CASE: 28 year-old woman who underwent gastrectomy for a diffuse type gastric cancer. Her family background showed multiple gastric cancers with inherited autosomal-dominant pattern (affectation of 9 members in 5 generations). Suspecting HDGC, a plan of surveillance endoscopy was iniciated, and a her DNA sample was sequenced for CDH1 gene finding a non-sense mutation in position 1913 G>A (W638X) of exon 12. CONCLUSION: the detailed recollection of the family background allowed to identify a rare inherited entity. The molecular testing confirmed the diagnosis and will allow future tailored counselling among relatives. PMID: 17955726 [PubMed - in process] Volver Arriba
17: Hereditary nonpolyposis colorectal cancer (lynch syndrome) in Argentina: report from a referral hospital register. Vaccaro CA, Bonadeo F, Roverano AV, Peltomaki P, Bala S, Renkonen E, Redal MA, Mocetti E, Mullen E, Ojea-Quintana G, Benati ML, Rivello HG, Clark MB, Lynch JF, Lynch HT. Department of Colorectal Surgery, Hospital Italiano de Buenos Aires, Guayaquil 226, 7B (1424) Capital Federal, Buenos Aires, Argentina,
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. PURPOSE: The first Argentine experience with epidemiologic, molecular, and genetic counseling data is reported. METHODS: We analyzed 43 families fulfilling Amsterdam criteria identified from a prospective database with data from 779 relatives. RESULTS: Eleven families (25.6 percent) presented as Lynch I, 29 (67.4 percent) as Lynch II, and 3 (7 percent) as Muir-Torre syndrome. Among the 306 affected members, 197 cases of colorectal cancer were identified (mean age at diagnosis, 52.1 (range, 21-90) years). The most frequent extracolonic tumors were gastric adenocarcinoma in males and endometrium adenocarcinoma in females. A high incidence of breast cancer was observed (16 cases among 155 females, crude rate: 11,594.20/100,000). Twenty-seven patients (8.8 percent) developed more than one tumor. These patients were younger than those with only one tumor (45 vs. 51 years; P = 0.001). In 5 of 11 patients who underwent molecular sequencing, a pathologic mutation was found. A novel C deletion at 1910 nucleotide, codon 637, exon 12 of MSH2 gene was identified in a family with a strong aggregation of breast cancer with lack of MSH2 immunohistochemical staining. For 78.2 percent of counseled inpiduals, this session represented the first time they received information, and 73.9 percent stated that their physicians were unaware of their family background. CONCLUSIONS: Argentine families presented a high incidence of stomach cancer. The elevated incidence of breast cancer and its association with a novel hMSH2 mutation bring to consideration the inclusion of this malignancy as part of the syndrome. A lack of awareness by both physicians and persons at risk was observed. PMID: 17846840 [PubMed - in process] Volver Arriba
Cirugía de Higado - Vías Biliares y Páncreas 0: World J Surg (2010) 34:2133–2140. Short-Term and Long-Term Outcomes After Simultaneous Resection of Colorectal Malignancies and Synchronous Liver Metastases Eduardo de Santibañes, Diego Fernandez, Carlos Vaccaro, Guillermo Ojea Quintana, Fernando Bonadeo, Juan Pekolj, Carlos Bonofiglio, Ernesto Molmenti.
Sección de Transplante Hepatobiliopancreático, Departamento de Cirugía General, Hospital Italiano, Buenos Aires, Argentina.
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Background: We evaluated the simultaneous resection of colorectal malignancies and synchronous liver metastases.
Methods: Between June 1982 and June 2006, a total of 752 patients underwent resection of colorectal hepatic metastases. In all, 185 (25%) of them underwent simultaneous resection of the hepatic lesions and the corresponding primary tumors.
Results: The median hospital stay was 8 days (range 4–24 days), with a median operating time of 4 h (range 2–8 h). Altogether, 62 (33.5%) patients required intraoperative transfusion of packed red blood cells (median 2.1 IU, range 1–5 IU), and 25 (13.5%) were given frozen fresh plasma (median 2.1 IU, range 1–4 IU). The morbidity rate was 20.5%. There were two postoperative deaths (mortality rate 1.08%) within 30 days of the surgical intervention. Major hepatectomy was associated with greater morbidity (37.2% vs. 16.2%, P\0.01) and mortality (4.7% vs. 0%, P\0.05) rates. For the overall survivals (OS) at 3 and 5 years were 60.1% (52.3–67.85%) and 36.1% (27.4-44.8%), respectively. Disease-free survivals (DFS) at 3 and 5 years were 37.7% (30.2–45.3%) and 26.5% (18.7–34.3%), respectively. Transfusion of blood products, CEA level C 200 ng/dl, and N2 node status were found to be prognostic factors by univariate analysis. CEA level C 200 ng/dl and N2 node status achieved prognostic significance by multivariate analysis.
Conclusions: The simultaneous resection of colorectal malignancies and synchronous livermetastases is safe, avoids an additional intervention, can be performed with low morbidity and mortality, and is associated with good oncologic outcomes.Node stage N2 and CEA level C 200 ng/dl should be given special consideration when selecting patients. Publication Types: English Abstract Volver Arriba
1: J Gastrointest Surg. 2007 Sep;11(9):1183-7. Epub 2007 Jul 11.
Liver metastasis resection: a simple technique that makes it easier. Eduardo de Santibañes, Rodrigo Sánchez Clariá, Martín Palavecino, Axel Beskow and Juan Pekolj Department of Surgery and Liver Transplant, Hospital Italiano de Buenos Aires, Gascon 450, Buenos Aires, Argentina,
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. Liver resection is the only therapeutic option that achieves long-term survival for patients with hepatic metastases. We propose a technique that causes traction and countertraction on the resection area, thus easily exposing the structures to be ligated. Because the parenchyma protrudes like a cork from a bottle, we named this procedure the "corkscrew technique". The objective of this work was to describe an original surgical technique to resect liver metastases. We delimit the resection area at 2 cm from the tumor. We place separated stitches, in a radiate way. The needle diameter must allow passing far from the deepest margin of the tumor. The stitches must be tractioned all together to separate the tumor from the normal parenchyma. Between the years 1983 and 2006, we perform 1,270 liver resections. We used the corkscrew technique-like procedure in only 612 patients, whereas in 129 patients, we associated it to an anatomic resection. Mortality was 1%. Morbidity was 16% with a reoperation rate of 3%. The corkscrew technique is simple and safe, spares surgical time, avoids blood loss, ensures free tumor margins, and is easy to perform. PMID: 17623257 [PubMed - in process] Volver Arriba
2: J Hepatobiliary Pancreat Surg. 2007;14(1):91-7. Epub 2007 Jan 30.
Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. Yuichi Yamashita, Tadahiro Takada, Yoshifumi Kawarada, Yuji Nimura, Masahiko Hirota, Fumihiko Miura, Toshihiko Mayumi, Masahiro Yoshida, Steven Strasberg, Henry A. Pitt, Eduardo de Santibanes, Jacques Belghiti, Markus W. Büchler, Dirk J. Gouma, Sheung-Tat Fan, Serafin C. Hilvano, Joseph W.Y. Lau, Sun-Whe Kim, Giulio Belli, John A. Windsor, Kui-Hin Liau and Vibul Sachakul Department of Surgery, Fukuoka University Hospital, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan. Cholecystectomy has been widely performed in the treatment of acute cholecystitis, and laparoscopic cholecystectomy has been increasingly adopted as the method of surgery over the past 15 years. Despite the success of laparoscopic cholecystectomy as an elective treatment for symptomatic gallstones, acute cholecystitis was initially considered a contraindication for laparoscopic cholecystectomy. The reasons for it being considered a contraindication were the technical difficulty of performing it in acute cholecystitis and the development of complications, including bile duct injury, bowel injury, and hepatic injury. However, laparoscopic cholecystectomy is now accepted as being safe for acute cholecystitis, when surgeons who are expert at the laparoscopic technique perform it. Laparoscopic cholecystectomy has been found to be superior to open cholecystectomy as a treatment for acute cholecystitis because of a lower incidence of complications, shorter length of postoperative hospital stay, quicker recuperation, and earlier return to work. However, laparoscopic cholecystectomy for acute cholecystitis has not become routine, because the timing and approach to the surgical management in patients with acute cholecystitis is still a matter of controversy. These Guidelines describe the timing of and the optimal surgical treatment of acute cholecystitis in a question-and-answer format. Publication Types:
Practice Guideline
Research Support, Non-U.S. Gov't PMID: 17252302 [PubMed - indexed for MEDLINE] Volver Arriba
3: J Hepatobiliary Pancreat Surg. 2007;14(1):83-90. Epub 2007 Jan 30. Related Articles, LinkOut Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines. Yoshida M, Takada T, Kawarada Y, Tanaka A, Nimura Y, Gomi H, Hirota M, Miura F, Wada K, Mayumi T, Solomkin JS, Strasberg S, Pitt HA, Belghiti J, de Santibanes E, Fan ST, Chen MF, Belli G, Hilvano SC, Kim SW, Ker CG. Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. Acute cholecystitis consists of various morbid conditions, ranging from mild cases that are relieved by the oral administration of antimicrobial drugs or that resolve even without antimicrobials to severe cases complicated by biliary peritonitis. Microbial cultures should be performed by collecting bile at all available opportunities to identify both aerobic and anaerobic organisms. Empirically selected antimicrobials should be administered. Antimicrobial activity against potential causative organisms, the severity of the cholecystitis, the patient's past history of antimicrobial therapy, and local susceptibility patterns (antibiogram) must be taken into consideration in the choice of antimicrobial drugs. In mild cases which closely mimic biliary colic, the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended to prevent the progression of inflammation (recommendation grade A). When causative organisms are identified, the antimicrobial drug should be changed for a narrower-spectrum antimicrobial agent on the basis of the species and their susceptibility testing results. Publication Types:
Practice Guideline
Research Support, Non-U.S. Gov't PMID: 17252301 [PubMed - indexed for MEDLINE] Volver Arriba
4: J Hepatobiliary Pancreat Surg. 2007;14(1):78-82. Epub 2007 Jan 30. Related Articles, LinkOut Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, Mayumi T, Yoshida M, Strasberg S, Pitt H, Gadacz TR, de Santibanes E, Gouma DJ, Solomkin JS, Belghiti J, Neuhaus H, Büchler MW, Fan ST, Ker CG, Padbury RT, Liau KH, Hilvano SC, Belli G, Windsor JA, Dervenis C. Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556, Japan. The aim of this article is to propose new criteria for the diagnosis and severity assessment of acute cholecystitis, based on a systematic review of the literature and a consensus of experts. A working group reviewed articles with regard to the diagnosis and treatment of acute cholecystitis and extracted the best current available evidence. In addition to the evidence and face-to-face discussions, domestic consensus meetings were held by the experts in order to assess the results. A provisional outcome statement regarding the diagnostic criteria and criteria for severity assessment was discussed and finalized during an International Consensus Meeting held in Tokyo 2006. Patients exhibiting one of the local signs of inflammation, such as Murphy's sign, or a mass, pain or tenderness in the right upper quadrant, as well as one of the systemic signs of inflammation, such as fever, elevated white blood cell count, and elevated C-reactive protein level, are diagnosed as having acute cholecystitis. Patients in whom suspected clinical findings are confirmed by diagnostic imaging are also diagnosed with acute cholecystitis. The severity of acute cholecystitis is classified into three grades, mild (grade I), moderate (grade II), and severe (grade III). Grade I (mild acute cholecystitis) is defined as acute cholecystitis in a patient with no organ dysfunction and limited disease in the gallbladder, making cholecystectomy a low-risk procedure. Grade II (moderate acute cholecystitis) is associated with no organ dysfunction but there is extensive disease in the gallbladder, resulting in difficulty in safely performing a cholecystectomy. Grade II disease is usually characterized by an elevated white blood cell count; a palpable, tender mass in the right upper abdominal quadrant; disease duration of more than 72 h; and imaging studies indicating significant inflammatory changes in the gallbladder. Grade III (severe acute cholecystitis) is defined as acute cholecystitis with organ dysfunction. Publication Types:
Practice Guideline
Research Support, Non-U.S. Gov't PMID: 17252300 [PubMed - indexed for MEDLINE] Volver Arriba
5: J Hepatobiliary Pancreat Surg. 2007;14(1):59-67. Epub 2007 Jan 30. Related Articles, Compound (MeSH Keyword), Substance (MeSH Keyword), LinkOut Antimicrobial therapy for acute cholangitis: Tokyo Guidelines. Tanaka A, Takada T, Kawarada Y, Nimura Y, Yoshida M, Miura F, Hirota M, Wada K, Mayumi T, Gomi H, Solomkin JS, Strasberg SM, Pitt HA, Belghiti J, de Santibanes E, Padbury R, Chen MF, Belli G, Ker CG, Hilvano SC, Fan ST, Liau KH. Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. Antimicrobial agents should be administered to all patients with suspected acute cholangitis as a priority as soon as possible. Bile cultures should be performed at the earliest opportunity. The important factors which should be considered in selecting antimicrobial therapy include the agent's activity against potentially infecting bacteria, the severity of the cholangitis, the presence or absence of renal and hepatic diseases, the patient's recent history of antimicrobial therapy, and any recent culture results, if available. Biliary penetration of the microbial agents should also be considered in the selection of antimicrobials, but activity against the infecting isolates is of greatest importance. If the causative organisms are identified, empirically chosen antimicrobial drugs should be replaced by narrower-spectrum antimicrobial agents, the most appropriate for the species and the site of the infection. Publication Types:
Practice Guideline
Research Support, Non-U.S. Gov't PMID: 17252298 [PubMed - indexed for MEDLINE] Volver Arriba
6: J Hepatobiliary Pancreat Surg. 2007;14(1):52-8. Epub 2007 Jan 30. Related Articles, LinkOut Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, Mayumi T, Strasberg S, Pitt HA, Gadacz TR, Büchler MW, Belghiti J, de Santibanes E, Gouma DJ, Neuhaus H, Dervenis C, Fan ST, Chen MF, Ker CG, Bornman PC, Hilvano SC, Kim SW, Liau KH, Kim MH. Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. Because acute cholangitis sometimes rapidly progresses to a severe form accompanied by organ dysfunction, caused by the systemic inflammatory response syndrome (SIRS) and/or sepsis, prompt diagnosis and severity assessment are necessary for appropriate management, including intensive care with organ support and urgent biliary drainage in addition to medical treatment. However, because there have been no standard criteria for the diagnosis and severity assessment of acute cholangitis, practical clinical guidelines have never been established. The aim of this part of the Tokyo Guidelines is to propose new criteria for the diagnosis and severity assessment of acute cholangitis based on a systematic review of the literature and the consensus of experts reached at the International Consensus Meeting held in Tokyo 2006. Acute cholangitis can be diagnosed if the clinical manifestations of Charcot's triad, i.e., fever and/or chills, abdominal pain (right upper quadrant or epigastric), and jaundice are present. When not all of the components of the triad are present, then a definite diagnosis can be made if laboratory data and imaging findings supporting the evidence of inflammation and biliary obstruction are obtained. The severity of acute cholangitis can be classified into three grades, mild (grade I), moderate (grade II), and severe (grade III), on the basis of two clinical factors, the onset of organ dysfunction and the response to the initial medical treatment. "Severe (grade III)" acute cholangitis is defined as acute cholangitis accompanied by at least one new-onset organ dysfunction. "Moderate (grade II)" acute cholangitis is defined as acute cholangitis that is unaccompanied by organ dysfunction, but that does not respond to the initial medical treatment, with the clinical manifestations and/or laboratory data not improved. "Mild (grade I)" acute cholangitis is defined as acute cholangitis that responds to the initial medical treatment, with the clinical findings improved. Publication Types:
Practice Guideline
Research Support, Non-U.S. Gov't PMID: 17252297 [PubMed - indexed for MEDLINE] Volver Arriba
7: J Hepatobiliary Pancreat Surg. 2007;14(1):35-45. Epub 2007 Jan 30. Related Articles, LinkOut Techniques of biliary drainage for acute cholangitis: Tokyo Guidelines. Tsuyuguchi T, Takada T, Kawarada Y, Nimura Y, Wada K, Nagino M, Mayumi T, Yoshida M, Miura F, Tanaka A, Yamashita Y, Hirota M, Hirata K, Yasuda H, Kimura Y, Strasberg S, Pitt H, Büchler MW, Neuhaus H, Belghiti J, de Santibanes E, Fan ST, Liau KH, Sachakul V. Department of Medicine and Clinical Oncology, Graduate School of Medicine Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. Biliary decompression and drainage done in a timely manner is the cornerstone of acute cholangitis treatment. The mortality rate of acute cholangitis was extremely high when no interventional procedures, other than open drainage, were available. At present, endoscopic drainage is the procedure of first choice, in view of its safety and effectiveness. In patients with severe (grade III) disease, defined according to the severity assessment criteria in the Guidelines, biliary drainage should be done promptly with respiration management, while patients with moderate (grade II) disease also need to undergo drainage promptly with close monitoring of their responses to the primary care. For endoscopic drainage, endoscopic nasobiliary drainage (ENBD) or stent placement procedures are performed. Randomized controlled trials (RCTs) have reported no difference in the drainage effect of these two procedures, but case-series studies have indicated the frequent occurrence of hemorrhage associated with endoscopic sphincterotomy (EST), and complications such as pancreatitis. Although the usefulness of percutaneous transhepatic drainage is supported by the case-series studies, its lower success rate and higher complication rates makes it a second-option procedure. Publication Types:
Practice Guideline
Research Support, Non-U.S. Gov't PMID: 17252295 [PubMed - indexed for MEDLINE] Volver Arriba
8: J Hepatobiliary Pancreat Surg. 2007;14(1):27-34. Epub 2007 Jan 30. Related Articles, LinkOut Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. Miura F, Takada T, Kawarada Y, Nimura Y, Wada K, Hirota M, Nagino M, Tsuyuguchi T, Mayumi T, Yoshida M, Strasberg SM, Pitt HA, Belghiti J, de Santibanes E, Gadacz TR, Gouma DJ, Fan ST, Chen MF, Padbury RT, Bornman PC, Kim SW, Liau KH, Belli G, Dervenis C. Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8605, Japan. Diagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis), according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic, percutaneous, or surgical treatment should be performed after the patient's general condition has improved. For patients with mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation, elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy. For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient's general medical condition. Publication Types:
Practice Guideline
Research Support, Non-U.S. Gov't PMID: 17252294 [PubMed - indexed for MEDLINE] Volver Arriba
9: J Hepatobiliary Pancreat Surg. 2007;14(1):11-4. Epub 2007 Jan 30. Related Articles, LinkOut Need for criteria for the diagnosis and severity assessment of acute cholangitis and cholecystitis: Tokyo Guidelines. Sekimoto M, Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Miura F, Wada K, Hirota M, Yamashita Y, Strasberg S, Pitt HA, Belghiti J, de Santibanes E, Gadacz TR, Hilvano SC, Kim SW, Liau KH, Fan ST, Belli G, Sachakul V. Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Konoe-cho, Yoshida, Sakyo-ku, Kyoto, 606-8501, Japan. The Tokyo Guidelines formulate clinical guidance for healthcare providers regarding the diagnosis, severity assessment, and treatment of acute cholangitis and acute cholecystitis. The Guidelines were developed through a comprehensive literature search and selection of evidence. Recommendations were based on the strength and quality of evidence. Expert consensus opinion was used to enhance or formulate important areas where data were insufficient. A working group, composed of gastroenterologists and surgeons with expertise in biliary tract surgery, supplemented with physicians in critical care medicine, epidemiology, and laboratory medicine, was selected to formulate draft guidelines. Several other groups (including members of the Japanese Society for Abdominal Emergency Medicine, the Japan Biliary Association, and the Japanese Society of Hepato-Biliary-Pancreatic Surgery) have reviewed and revised the draft guidelines. To build a global consensus on the management of acute biliary infection, an international expert panel, representing experts in this area, was established. Between April 1 and 2, 2006, an International Consensus Meeting on acute biliary infections was held in Tokyo. A consensus was determined based on best available scientific evidence and discussion by the panel of experts. This report describes the highlights of the Tokyo International Consensus Meeting in 2006. Some important areas focused on at the meeting include proposals for internationally accepted diagnostic criteria and severity assessment for both clinical and research purposes. Publication Types:
Research Support, Non-U.S. Gov't PMID: 17252292 [PubMed - indexed for MEDLINE] Volver Arriba
10: Surg Endosc. 2006 Nov;20(11):1648-53. Epub 2006 Oct 23. Related Articles, LinkOut
Bile duct injuries: management of late complications.
de Santibañes E, Palavecino M, Ardiles V, Pekolj J. General Surgery and Liver Transplantation Unit, Hospital Italiano de Buenos Aires, Esmeralda 1319 4to piso 4to cuerpo CP 1007, Buenos Aires, Argentina.
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BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice for gallbladder stones. In the current study, this approach was associated with a higher incidence of biliary injuries. The authors evaluate their experience treating complex biliary injuries and analyze the literature. METHODS: In a 15-year period, 169 patients with bile duct injuries (BDIs) resulting from open and laparoscopic cholecystectomies were treated. The patients were retrospectively evaluated through their records. Biliary injury and associated lesions were evaluated with imaging studies. Surgical management included therapeutic endoscopy, percutaneous interventions, hepaticojejunostomy, liver resection, and liver transplantation. Postoperative outcome was recorded. Survival analysis was performed with G-Stat and NCSS programs using the Kaplan-Meier method. RESULTS: Of the 169 patients treated for BDIs, 148 were referred from other centers. The injuries included 115 lesions resulting from open cholecystectomy and 54 lesions resulting from laparoscopic cholecystectomy. A total of 110 patients (65%) fulfilled the criteria for complex injuries, 11 of whom met more than one criteria. Injuries resulting from laparoscopic and open cholecystectomies were complex in 87.5% and 72% of the patients, respectively. The procedures used were percutaneous transhepatic biliary drainage for 30 patients, hepaticojejunostomy for 96 patients, rehepaticojejunostomy for 16 patients, hepatic resection for 9 patients, and liver transplantation projected for 18 patients. Hepaticojejunostomy was effective for 85% of the patients. The mean follow-up period was 77.8 months (range, 4-168 months). The mortality rate for noncomplex BDI was 0%, as compared with the mortality rate of 7.2% (8/110) for complex BDI. Mortality after hepatic resection was nil, and morbidity was 33.3%. The actuarial survival rate for liver transplantation at 1 year was 91.7%. CONCLUSIONS: Complex BDIs after laparoscopic cholecystectomy are potentially life-threatening complications. In this study, late complications of complex BDIs appeared when there was a delay in referral or the patient received multiple procedures. On occasion, hepatic resections and liver transplantation proved to be the only definitive treatments with good long-term outcomes and quality of life. PMID: 17063285 [PubMed - indexed for MEDLINE] Volver Arriba
11: Liver Transpl. 2005 Sep;11(9):1112-6. Related Articles, Cited in PMC, LinkOut
Erratum in:
Liver Transpl. 2005 Dec;11(12):1617. Lunaó, Concepción [corrected to Luna, Concepción]; De RissioÃ, Ana MarÃa [corrected to De Rissio, Ana MarÃa]; Gadanoá, Adrián [corrected to Gadano, Adrián].
Transmission of T. cruzi infection via liver transplantation to a nonreactive recipient for Chagas' disease. Barcán L, Luna C, Clara L, Sinagra A, Valledor A, De Rissio AM, Gadano A, GarcÃa MM, de Santibañes E, Riarte A. Infectious Disease Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Chagas' disease is an endemic zoonosis of South America caused by a protozoan parasite Trypanosoma cruzi. About 30% of infected people develop the disease. This disease is known to reactivate in immunocompromised hosts, such as patients with acquired immunodeficiency syndrome, leukemia, and transplantation. There is some experience with transplantation of infected renal grafts into negative recipients, resulting in an index of transmission of 35%. No cases have been reported involving other organ transplants up to 2002, when the Centers for Disease Control and Prevention reported 3 cases of Chagas' disease transmission to 3 recipients (liver, kidney, and pancreas-kidney) from a single chagas infected donor. Here we report on a case of orthotopic liver transplant from a chagas infected donor into a negative recipient in clinical emergency status. The recipient was monitored by direct parasitological Strout method and serological tests with detection of transmission on the 84 th day by both studies, without clinical signs. The patient was put on benznidazole with rapid clearance of the parasitemia. However, we propose that chagas infected donors may be accepted for liver transplant recipients only in emergency status. Publication Types:
Case Reports PMID: 16123968 [PubMed - indexed for MEDLINE] Volver Arriba
12: Acta Gastroenterol Latinoam. 2004;34(2):61-8. Related Articles, LinkOut Percutaneous management of benign pathology of the main biliary tract: experience in a section of pancreatic and hepatobiliary surgery [Article in Spanish] Stork G, de Santibañes E, Mazza O, Quiñonez E, Moro M, Palavecino M, Pekolj J. Sección de CirugÃa Hepato-Bilio-Pancreática y Trasplante Hepático, Servicio de CirugÃa General, Hospital Italiano de Buenos Aires, Gascón 450, Buenos Aires, Argentina.
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BACKGROUND: Biliary percutaneous procedures (BPP) are useful on management of benign biliary pathology. OBJECTIVE: Communicate our experience with percutaneous biliary procedures made by surgeons in a specific Hepato-Pancreato-Biliary Section. POPULATION: Retrospective evaluation in 84 patients with benign biliary diseases, treated with BPP from January 1989 through January 2002. RESULTS: Diagnosis common bile duct stones 21 patients, strictures after common bile duct injury (SCBDI) 29 patients, and other benign bile duct strictures (OBBDS) 34 patients. INDICATIONS: Acute cholangitis 45, pruritus 11, high surgical risk 10, contraindicated or failed endoscopic access 9, before liver transplantation 12 and other causes 3. Procedures (n=141): percutaneous drainage 96, stricture dilatation 27, percutaneous stone treatment 12, stents 5 and biopsy 1. EFFECTIVENESS: Cholangitis 94.8%, stones 100%, anastomotic stricture dilatation (by SCBDI 45.5% and by OBBDS 90%). COMPLICATIONS: Total 32 (38.1%). MORTALITY: 3 (3.6%). CONCLUSIONS: 1-Percutaneous drainage was an effective method for bile duct decompression in acute cholangitis, allowing an elective and definitive treatment of the pathology. 2-BPP solved strictures in patients with a high surgical risk and in those with complex diseases. 3-The results of biliary percutaneous dilatation were related to their etiology. Publication Types:
English Abstract PMID: 15481795 [PubMed - indexed for MEDLINE] Volver Arriba
13: Acta Gastroenterol Latinoam. 2004;34(1):21-6. Related Articles, LinkOut
Hepatic tuberculoma: presentation of cases and review of the literature
[Article in Spanish] Ardiles V, Rossi G, Acuña Barrios J, Romero Vecce R, Mullen E, López MM, de Santibáñes E. CirugÃa General Hospital Italiano, Buenos Aires. Hepatic involvement by tuberculosis is a rare type of manifestation of the disease. There are several forms of clinical presentations. One of them is the hepatic tuberculoma in which we base our presentation. Given that hepatic tuberculoma is a rare entity and generally shows inespecific symptoms, it is rarely suspected by the clinical picture. The diagnosis of hepatic tuberculosis is generally done in the intraoperative or postoperative period by analyzing a specimen taken by laparoscopy or laparotomy during the study of a hepatic mass. Laboratory tests or image studies do not give pathognomonic information to conform the diagnosis. The cornerstone in the treatment of this pathology is the antituberculous therapy. Surgical or endoscopic interventions are occasionally required. The role of surgery in the treatment of this pathology is reserved for a few solitary lesions. Once the correct treatment is performed the outcome is favorable. We present 4 cases of hepatic tuberculoma with different imaging and clinical presentations. Publication Types:
Case Reports
English Abstract
Review PMID: 15328664 [PubMed - indexed for MEDLINE] Volver Arriba
14: Acta Gastroenterol Latinoam. 2004;34(1):9-15. Related Articles, LinkOut Complications of hepatic resection surgery: a 12-month experience in a high case-load specialized center [Article in Spanish] Stork G, Pekolj J, Bonofiglio C, Ciardullo M, Moro M, Quiñonez E, Palavecino M, de Santibañes E. Sección de CirugÃa Hepato Bilio Pancreática y Trasplante Hepático, Servicio de CirugÃa General, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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BACKGROUND: Surgical treatment indications in benign and malignant hepatic tumors changed in last 20 years. Total number of hepatic resections increased in reference centers. OBJECTIVE: To evaluate complications after hepatic resections in a specific center, during a 12 months period. Methods: Between January 2001 and January 2002, 80 patients with hepatic resection were analyzed. Mean age 55 years (r:14-79). Female: 55%. We analyze: tumor specifications, hepatic resection performed, transfusions, vascular clamping, operative time, associated procedures, length of hospital stage, postoperative complications and mortality. RESULTS: 61 patients (76.2%) were treated because of malignant pathology and 19 for benign. In 30 patients (37.5%) was made major resections and minor in 50 (62.5%). 16 patients (20%) required blood transfusions. Vascular intermittent clamping was used in 66 patients (82.5%). Associated procedures were made in 46 patients (58%). Mean operative time was 200'. Mean hospital stage: 6 days (r:3-12). Morbidity: 15 patients (18.7%). Complications were significantly higher in patients with: major hepatic resections (p: 0.002); primary hepatic tumors (p: 0.01); mean operative time more than 200' (p: 0.00007). Mortality associated with the procedure: 0%. CONCLUSIONS: 1-Hepatic resections performed in high volume centers have a low complication risk and almost with no mortality. 2-Major hepatic resection, primary malignant tumors and mean operative time more than 200', were risk factors associated with postoperative complications. Publication Types:
English Abstract PMID: 15328662 [PubMed - indexed for MEDLINE] Volver Arriba
15: Lupus. 2003;12(2):140-3. Related Articles, LinkOut
Catastrophic antiphospholipid syndrome complicating orthotopic liver transplantation.
Villamil A, Sorkin E, Basta MC, Mysler E, Macias S, Pekolj J, Ciardullo M, Eleta F, de Santibañes E, Allievi A, Gadano A. Liver Transplantation Unit, Hospital Italiano de Buenos Aires, Argentina. Catastrophic antiphospholipid syndrome (CAPS) is an acutely devastating situation characterized by widespread thrombotic microangiopathy in the presence of elevated titers of antiphospholipid antibodies. We describe a 57-year old woman who underwent liver transplantation for primary sclerosing cholangitis and developed this malignant variant of the antiphospholipid syndrome. Publication Types:
Case Reports PMID: 12630760 [PubMed - indexed for MEDLINE] Volver Arriba
16: J Am Coll Surg. 2002 Aug;195(2):196-202. Related Articles, LinkOut
Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes.
de Santibañes E, Lassalle FB, McCormack L, Pekolj J, Quintana GO, Vaccaro C, Benati M. Hepato Pancreatic Biliary and Liver Transplantation Section, Department of General Surgery, Hospital Italiano, Buenos Aires, Argentina. BACKGROUND: Our goal was to analyze the results of resection of colorectal cancer and liver metastases in one procedure. STUDY DESIGN: Between June 1982 and July 1998, 522 patients underwent liver resection for colorectal metastases. Liver resection was performed simultaneously with colorectal resection in 71 cases, representing the population in this study. Morbidity, mortality, overall survival, and disease-free survival times were analyzed. Median followup time was 29 months (range 6 to 162 months). Prognostic factors and their influence on outcomes were analyzed. RESULTS: The median hospital stay was 8 days (range 5 to 23 days). Morbidity was 21% and included nine pleural effusions, seven wound abscesses, four instances of hepatic failure, three systemic infections, three intraabdominal abscesses, and one colonic anastomosis leakage. Operative mortality was 0%. Recurrence rate was 57.7% (41 or 71), and progression of disease was detected in 33.8%. Overall and disease-free survivals at 1, 3, and 5 years were 88%, 45%, and 38% and 67%, 17%, and 9%, respectively. Prognostic factors with notable influence on patient outcomes were nodal stage as per TNM classification, number of liver metastases, diameter (smaller or larger than 5 cm), liver resection specimen weight (lighter or heavier than 90 g), and liver resection margin (smaller or larger than 1 cm). CONCLUSIONS: Simultaneous resection of colorectal cancer and liver metastases can be performed with low morbidity and mortality rates, avoiding a second surgical procedure. PMID: 12168966 [PubMed - indexed for MEDLINE] Volver Arriba
17: Acta Gastroenterol Latinoam. 2001;31(5):367-75. Related Articles, LinkOut Multimodal treatment of hepatocellular carcinoma [Article in Spanish] De Santibañes E, Mc Cormack L, Pekolj J, Mattera J, Acuña Barrios J, Aldet A, GarcÃa Monaco R, Gadano A, D'Agostino D, Bonofiglio C, Ciardullo M. Hospital Italiano de Buenos Aires (HIBA).
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BACKGROUND: Several options now available create the need for a multidisciplinary approach to the treatment of patients with hepatocellular carcinoma (HCC). OBJECTIVE: To describe the experience with a group of patients with HCC diagnosed and treated with the current modalities for control of this entity. POPULATION AND METHOD: A total of 169 consecutive patients with HCC treated between January 1990 and February 1998; 41 liver resections, 14 liver transplants, 87 chemoembolizations and 8 alcoholizations were performed. The median follow-up time was 23.6 months (range: 0.2-94). In the other 29 patients, only support treatment was administered. RESULTS: Resected patients had a lower median hospitalization rate, blood transfusions, and hospitalization mortality. Recurrence was 42.1% in the resected group but 0% in transplanted patients. The overall survival at 36 months was better for transplanted than for resected patients (100% vs. 62.3%; p < 0.02). The median survival time was 13 months (IC: 95%: 11-15 months) in chemoembolizated patients. CONCLUSIONS: 1. The outcome of patients with HCC is influenced by several factors, therefore calling for multimodal approach. 2. Surgical procedures should be indicated with low morbimortality rates. 3. The overall survival and disease free survival time is better in transplanted patients than in the resected group. 4. The survival time of patients with unresectable HCC without extra-liver disease could be improved with chemoembolization. Publication Types:
English Abstract PMID: 11873663 [PubMed - indexed for MEDLINE] Volver Arriba
18: J Hepatol. 2001 Oct;35(4):452-6. Related Articles, Cited in PMC, LinkOut
Nitric oxide synthase activity in the splanchnic vasculature of patients with cirrhosis: relationship with hemodynamic disturbances.
Albornoz L, Motta A, Alvarez D, Estevez A, Bandi JC, McCormack L, Matera J, Bonofiglio C, Ciardullo M, De Santibañes E, Gimeno M, Gadan A. Sección de HÃgado, Servicio de ClÃnic a Medica, Hospital Italiano, Buenos Aires, Argentina. BACKGROUND/AIMS: It has been demonstrated that an overproduction of nitric oxide plays an important role in the pathogenesis of the hyperdynamic circulation exhibited by cirrhotic patients. Nevertheless, evidence is supported by studies performed in experimental models or by indirect measurements in humans. The purpose of this study has been to evaluate nitric oxide production in splanchnic vasculature of patients with cirrhosis and to investigate its possible relationship with systemic and splanchnic hemodynamics. METHODS: Nitric oxide synthase (NOS) activity was measured in hepatic artery and portal vein tissues of nine cirrhotic patients. Samples were obtained during liver transplantation. Control samples were obtained simultaneously from the corresponding tissues of the liver donors. Hemodynamic parameters were determined with Doppler ultrasonography. RESULTS: NOS activity was significantly higher in hepatic artery of cirrhotic patients than in controls (8.17 +/- 1.30 vs 4.57 +/- 0.61 pmoles/g of tissue/min, P < 0.05). Patients with ascites showed a higher hepatic artery NOS activity than patients without ascites. Highly significant correlation was observed between cardiac output and hepatic artery NOS activity as well as between portal blood flow and hepatic artery NOS activity. CONCLUSIONS: The present study demonstrates an enhanced production of nitric oxide in the splanchnic vasculature of patients with cirrhosis. PMID: 11682028 [PubMed - indexed for MEDLINE] Volver Arriba
19: Liver Transpl. 2000 Jan;6(1):108-12. Related Articles, LinkOut Partial left lateral segment transplant from a living donor. de Santibañes E, McCormack L, Mattera J, Pekolj J, SÃvori J, Beskow A, D'Agostino D, Ciardullo M. Hospital Italiano, Buenos Aires, Argentina. A shortage of liver donors for low-weight transplant recipients has prompted the development of procedures for liver-reduction, split-liver, and living related donor transplantations. For pediatric recipients weighing less than 10 kg, the left lateral segment is often still too large. We describe the procedure of monosegmental transplantation using segment II after segment III was resected in situ from a living related donor. Successful monosegmental transplantation is technically feasible and is a valid alternative to be considered for cases of size discrepancy between the recipient's volume and the donor's left lateral segment. Publication Types:
Case Reports PMID: 10648588 [PubMed - indexed for MEDLINE] Volver Arriba
20: J Pediatr Surg. 1998 Jun;33(6):938-40. Related Articles, LinkOut Liver transplantation as treatment for arterioportal fistulae. D'Agostino D, GarcÃa Mónaco R, Alonso V, Iñón A, Ciardullo M, de Santibañes E. Department of Pediatrics, Hospital Italiano de Buenos Aires, Argentina. The authors present the case of a 14-year-old boy with secondary portal hypertension caused by arterio-portal fistulae. Ascites, edema, severe abdominal pain, and steatorrhea developed in the patient. In an attempt to decrease arterioportal flow the authors carried out vascular embolization that was partially successful. A liver transplant was performed as a last therapeutic resource in view of the fact that it constitutes an accepted therapy for patients with severe liver disease. Orthotopic liver transplantation may be considered as another possible treatment of arterio-portal fistulae. Publication Types:
Case Reports PMID: 9660234 [PubMed - indexed for MEDLINE] Volver Arriba
21: Liver Transpl Surg. 1998 Jul;4(4):300-3. Related Articles, LinkOut Splanchnic hyperemia after liver transplantation in patients with end-stage liver disease. Alvarez D, Gerona S, Waisburg Z, Ciardullo M, de Santibañes E, Mastai R. Sección de EcografÃa, Buenos Aires, Argentina. Systemic and splanchnic hemodynamic parameters were evaluated in 12 patients with cirrhosis before and 3 and 6 months after liver transplantation. Results were compared with those obtained in 8 healthy subjects. Three months after liver transplantation recipients had an increase in mean arterial pressure (98 +/- 7 v 78 +/- 9 mmHg; P < .05), an insignificant decrease in cardiac index (3. 4 +/- 0.6 v 4.0 +/- 1.0 L . min-1 . m-2), and a marked increase in peripheral vascular resistance (1,563 +/- 308 v 800 +/- 205 dyne . s . cm-5; P < .05) compared with pretransplantation values. Portal blood flow was also significantly increased (1,494 +/- 200 v 829 +/- 130 mL/min; P < .05). These hemodynamic changes were more pronounced 6 months after transplantation (mean arterial pressure, 100 +/- 8 mmHg; cardiac index, 3.0 +/- 1.0 L . min-1 . m-2; P < .01; peripheral vascular resistance, 1,680 +/- 405 dyne . s . cm-5; portal blood flow, 1,520 +/- 180 mL/min). Systemic hemodynamics 6 months after liver transplantation were similar to those observed in the healthy control group (mean arterial pressure, 95 +/- 6 mmHg; cardiac index, 2.9 +/- 0.9 L . min-1 . m-2; peripheral vascular resistance, 1,480 +/- 380 dyne . s . cm-5). However, portal blood flow was still significantly higher than in healthy controls at 6 months (1,520 +/- 180 v 910 +/- 140 mL/min; P < .05). This study shows that systemic hemodynamics are normalized after liver transplantation. However, an increase in portal blood flow occurs and persists for at least 6 months after liver transplantation. Further studies are needed to clarify the cause of the abnormally high portal flows. Copyright 1998 W.B. Saunders Company. Publication Types:
Comparative Study PMID: 9649644 [PubMed - indexed for MEDLINE] Volver Arriba
22: Acta Gastroenterol Latinoam. 1997;27(3):113-7. Related Articles, LinkOut
Renal failure in patients with liver transplant: incidence and predisposing factors
[Article in Spanish] Gerona S, Laudano O, MacÃas S, San Román E, Galdame O, Torres O, Sorkin E, Ciardullo M, de Santibañes E, Mastai R. Programa de Transplante Hepático, Hospital Italiano, Buenos Aires, Argentina. Renal failure is a common finding in patients undergoing orthotopic liver transplantation. The aim of the present study was to evaluate the incidence, prognostic value of pre, intra and postoperative factors and severity of renal dysfunction in patients who undergo liver transplantation. Therefore, the records of 38 consecutive adult patients were reviewed. Renal failure was defined arbitrarily as an increase in creatinine (> 1.5 mg/dl) and/or blood urea (> 80 mg/dl). Three patients were excluded of the final analysis (1 acute liver failure and 2 with a survival lower than 72 hs.) Twenty one of the 35 patients has renal failure after orthotopic liver transplantation. Six of these episodes developed early, having occurred within the first 6 days. Late renal impairment occurred in 15 patients within the hospitalization (40 +/- 10 days) (Mean +/- SD). In he overall series, liver function, evaluated by Child-Pugh classification, a higher blood-related requirements and cyclosporine levels were observed more in those who experienced renal failure than those who did not (p < 0.05). Early renal failure was related with preoperative (liver function) and intraoperative (blood requirements) factors and several causes (nephrotoxic drugs and graft failure) other than cyclosporine were present in patients who developed late renal impairment. No mortality. No mortality was associated with renal failure. We conclude that renal failure a) is a common finding after liver transplantation, b) the pathogenesis of this complication is multifactorial and, c) in not related with a poor outcome. Publication Types:
English Abstract PMID: 9412139 [PubMed - indexed for MEDLINE] Volver Arriba
23: Transplant Proc. 1996 Apr;28(2):749-50. Related Articles, LinkOut
Extracorporeal auxiliary xenoperfusion: animal model of support in fulminant liver failure.
Argibay P, Vazquez J, Barros P, Vergé D, Nuñez F, Garcia H, Pekolj J, de Santibañes E. Unidad de Medicina Experimental, Hospital Italiano de Buenos Aires, Argentina. PMID: 8623379 [PubMed - indexed for MEDLINE] Volver Arriba
24: Acta Gastroenterol Latinoam. 1996;26(1):7-13. Related Articles, LinkOut Current therapeutic approach to acute acalculous cholecystitis [Article in Spanish] Mc Cormack L, Pekolj J, de Santibañes E, SÃvori J. Servicio de CirugÃa General, Hospital Italiano de Buenos Aires. Image-guided percutaneous transhepatic cholecystostomy (PTC) was suspected Acute Acalculous Cholecystitis (AAC). Seven of them developed AAC at home while eight patients developed the disease while hospitalized by critical illness. We performed PTC with Seldinger technique, guided: 13 by US CT. In every cases the catheter was placed successfully AAC was confirmed in 14/15 patients. No severe complications were related to the procedure. All but 3 improved following PTC: 2 required cholecystectomy because of diffuse gallbladder gangrene and one died by sepsis 48 hs after PTC. Light complications were: 1 homobilia and fever by 36 hs. In this series mobility was 35% and mortality 21%. Thus 9 patients with AAC were cured with PTC and are alive and symptom-free without surgery. PTC failed in 3/14 patients and other 2 died by causes unrelated to biliary disease. We conclude that PTC is a safe and effective temporary method for definitive treatment of AAC. Surgery is limited to that cases with generalized peritonitis and those when PTC has fallen. Publication Types:
Clinical Trial
English Abstract PMID: 9137651 [PubMed - indexed for MEDLINE] Volver Arriba
25: Am J Surg. 1984 May;147(5):677-80. Related Articles, Compound (MeSH Keyword), Substance (MeSH Keyword), LinkOut
Total pancreaticoduodenal homotransplantation in dogs immunosuppressed with cyclosporine and steroids.
Diliz-Perez HS, Hong HQ, de Santibanes E, Bedetti C, Iwatsuki S, Shaw BW Jr, Starzl TE. Pancreaticoduodenal transplantation was performed with cyclosporine and steroid immunosuppressive therapy in 10 mongrel dogs that had pancreaticoduodenectomy. There was an average animal survival of 50.6 days and an average duration of normoglycemia of 41.8 days. We suggest that pancreaticoduodenal transplantation, which was abandoned as a clinical procedure 10 years ago, be reconsidered for clinical application. Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S. PMID: 6372529 [PubMed - indexed for MEDLINE] Volver Arriba
26: Transplantation. 1984 Feb;37(2):126-9. Related Articles, Compound (MeSH Keyword), Substance (MeSH Keyword), Cited in PMC, LinkOut
Successful small bowel allotransplantation in dogs with cyclosporine and prednisone.
Diliz-Perez HS, McClure J, Bedetti C, Hong HQ, de Santibanes E, Shaw BW Jr, van Thiel D, Iwatsuki S, Starzl TE. Twelve dogs had transplantation of almost the entire small intestine in the orthotopic location; immunosuppression was with cyclosporine and prednisone. Half the dogs had survival of at least one month, and a third lived for at least four months. Two of the animals are still living after 550 and 555 days. Maintenance of nutrition, and absorption of D-xylose and fat were better than in control animals with an iatrogenic short gut syndrome, but distinctly worse than that of normal dogs. Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S. PMID: 6695451 [PubMed - indexed for MEDLINE] Volver Arriba
27: Acta Gastroenterol Latinoam. 1983;13(4):741-4. Related Articles, LinkOut
Liver transplantation: current status
[Article in Spanish] Campra JL, Pérez V, de Santibañes E. Publication Types:
Editorial PMID: 6391063 [PubMed - indexed for MEDLINE] Volver Arriba
Transplante Renopancreático, Celular y Medicina Regenerativa 1: Learn Mem. 2007 Apr 10;14(4):295-303. Reconsolidation of declarative memory in humans. Forcato C, Burgos VL, Argibay PF, Molina VA, Pedreira ME, Maldonado H. Laboratorio de Neurobiología de la Memoria, Departamento de Fisiología y Biología Molecular y Celular, IFIBYNE-CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina. The reconsolidation hypothesis states that a consolidated memory could again become unstable and susceptible to facilitation or impairment for a discrete period of time after a reminder presentation. The phenomenon has been demonstrated in very perse species and types of memory, including the human procedural memory of a motor skill task but not the human declarative one. Here we provide evidence for both consolidation and reconsolidation in a paired-associate learning (i.e., learning an association between a cue syllable and the respective response syllable).
Subjects were given two training sessions with a 24-h interval on distinct verbal material, and afterward, they received at testing two successive retrievals corresponding to the first and second learning, respectively.
Two main results are noted. First, the first acquired memory was impaired when a reminder was presented 5 min before the second training (reconsolidation), and also when the second training was given 5 min instead of 24 h after the first one (consolidation). Second, the first retrieval proved to influence negatively on the later one (the retrieval-induced forgetting [RIF] effect), and we used the absence of this RIF effect as a very indicator of the target memory impairment. We consider the demonstration of reconsolidation in human declarative memory as backing the universality of this phenomenon and having potential clinical relevance. On the other hand, we discuss the possibility of using the human declarative memory as a model to address several key topics of the reconsolidation hypothesis. Publication Types: Randomized Controlled TrialResearch Support, Non-U.S.
Gov't PMID: 17522018 Volver Arriba
2: Acta Gastroenterol Latinoam. 2006 Dec;36(4):170-3. Medicine and research: an indissoluble relationship [Article in Spanish] Argibay PF. Volver Arriba
3: Neuropathology. 2006 Dec;26(6):501-7 Compound (MeSH Keyword), Substance (MeSH Keyword), LinkOut Differential expression of glycans in the hippocampus of rats trained on an inhibitory learning paradigm. Hidalgo A, Burgos V, Viola H, Medina J, Argibay P. Institute of Basic Sciences and Experimental Medicine, Italian Hospital of Buenos Aires. The glycan chains of glycoconjugates play important roles in cell-cell and cell-matrix interactions. In the CNS, previous studies on learning and memory suggest the importance of oligosaccharides attached to glycoconjugates in the modulation of synaptic connections. We studied the hippocampal glycan distribution of rats subject to an inhibitory avoidance task. The expression of glycans was examined by lectin-histochemistry using Vicia villosa lectin (VVL) for terminal alpha/beta N-acetylgalactosamine (alpha/beta GalNAc); Galanthus nivalus lectin (GNL) for terminal mannose alpha-1,3 (Man alpha-1,3); Peanut agglutinin (PNA) for galactose beta-1,3N-acetylgalactosamine (Gal beta-1,3 GalNAc); Erythrina cristagalli lectin (ECL) for galactose beta-1,4 N-acetylglucosamine (Gal beta-1,4 GlcNAc); Sambucus nigra lectin (SNA) for sialic acid alpha-2.6 galactose (SA alpha-2,6 Gal); Maackia amurensis lectin II (MAL II) for sialic acid alpha-2,3 (SA alpha-2,3); Wheat germ agglutinin (WGA) for terminal N-acetylglucosamine with/ without sialic acid (GlcNAc wo SA); succynilated WGA (sWGA) for terminal N-acetylglucosamine without sialic acid (terminal GlcNAc without SA); Griffonia simplicifolia lectin II (GSL II) for terminal alpha/beta N-acetylglucosamine (alpha/beta GlcNAc terminal); and Lotus tetragonolobus lectin (LTL) alpha-fucose. Two groups of 10 animals were examined:
non-trained (Control) and Trained rats. ECL, sWGA and GSL II were negative for both groups in all the hippocampal subfields studied. For both groups, VVL was negative in CA4 and granular cells of the Dentate Gyrus (DG) and LTL was negative in the CA4 subfield. Expression of alpha/beta GalNAc, alpha-fucose and GlcNAc in other hippocampal subflields was positive, with no differences between groups. However, expression of Man alpha-1,3 was significantly higher in the CA1, CA2, CA3, and CA4 subfields in the Trained group. On the other hand, expression of Gal beta-1,3 GalNAc was significantly low in CA4 and DG in the Trained group. In conclusion, the results here presented indicate that the exposure of rats to an associative behavioral paradigm related to declarative memory, involves some regulatory mechanism/s for the differential patterns of glycan expression. PMID: 17203585 [PubMed - indexed for MEDLINE] Volver Arriba
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