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Cuadrado A, Fortea JI, Rodríguez-Lope C, Puente Á, Fernández-Vilchez V, Echavarria VJ, Castillo Suescun FJ, Fernández R, Echeverri JA, Achalandabaso M, Toledo E, Pellón R, Rodríguez Sanjuan JC, Crespo J, Fábrega E. Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients. J Clin Med 2023; 12:5457. [PMID: 37685524 PMCID: PMC10488177 DOI: 10.3390/jcm12175457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
Liver transplantation (LT) is a curative treatment for early-stage hepatocellular carcinoma (HCC) unsuitable for surgical resection. However, tumor recurrence (TR) rates range from 8% to 20% despite strict selection criteria. The validation of new prognostic tools, such as pre-MORAL or RETREAT risks, is necessary to improve recurrence prediction. A retrospective study was conducted at Marqués de Valdecilla University Hospital in Cantabria, Spain, between 2010 and 2019 to determine the rate of TR in LT patients and identify associated factors. Patients with liver-kidney transplantation, re-transplantation, HIV infection, survival less than 90 days, or incidental HCC were excluded. Data on demographic, liver disease-related, LT, and tumor-related variables, as well as follow-up records, including TR and death, were collected. TR was analyzed using the Log-Rank test, and a multivariate Cox regression analysis was performed. The study was approved by the IRB of Cantabria. TR occurred in 13.6% of LT patients (95% CI = 7.3-23.9), primarily as extrahepatic recurrence (67%) within the first 5 years (75%). Increased TR was significantly associated with higher Body Mass Index (BMI) (HR = 1.3 [95% CI = 1.1-1.5]), vascular micro-invasion (HR = 8.8 [1.6-48.0]), and medium (HR = 20.4 [3.0-140.4]) and high pre-MORAL risk (HR = 30.2 [1.6-568.6]). TR also showed a significant correlation with increased mortality. Conclusions: LT for HCC results in a 13.6% rate of tumor recurrence. Factors such as BMI, vascular micro-invasion, and medium/high pre-MORAL risk are strongly associated with TR following LT.
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Affiliation(s)
- Antonio Cuadrado
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, 39011 Santander, Spain
| | - José Ignacio Fortea
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, 39011 Santander, Spain
| | - Carlos Rodríguez-Lope
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, 39011 Santander, Spain
| | - Ángela Puente
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, 39011 Santander, Spain
| | - Vanesa Fernández-Vilchez
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, 39011 Santander, Spain
| | - Victor Jose Echavarria
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, 39011 Santander, Spain
| | | | - Roberto Fernández
- General Surgery Service, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | - Juan Andrés Echeverri
- General Surgery Service, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | - Mar Achalandabaso
- General Surgery Service, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | - Enrique Toledo
- General Surgery Service, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | - Raúl Pellón
- Radiology Service, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | | | - Javier Crespo
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, 39011 Santander, Spain
| | - Emilio Fábrega
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, 39011 Santander, Spain
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Odriozola A, Lamadrid-Perojo P, Cuadrado A, San Segundo D, del Barrio M, Fortea JI, Puente A, Amigo L, Fernández-Santiago R, Castillo F, Achalandabaso M, Andrés Echeverri J, Rodríguez-Sanjuan JC, López-Hoyos M, Crespo J, Fábrega E. Immune Response After a Third Dose of the mRNA-1273 SARS-CoV-2 Vaccine in Liver Transplant Recipients. Transplantation 2022; 106:e341-e342. [PMID: 35323163 PMCID: PMC9213066 DOI: 10.1097/tp.0000000000004147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Aitor Odriozola
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - Patricia Lamadrid-Perojo
- Department of Immunology, Marqués de Valdecilla University Hospital, IDIVAL, Transplant and Autoimmunity Research Group, University of Cantabria, Santander, Spain
| | - Antonio Cuadrado
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - David San Segundo
- Department of Immunology, Marqués de Valdecilla University Hospital, IDIVAL, Transplant and Autoimmunity Research Group, University of Cantabria, Santander, Spain
| | - María del Barrio
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - José Ignacio Fortea
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - Angela Puente
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - Lidia Amigo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - Roberto Fernández-Santiago
- Department of General Surgery, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Federico Castillo
- Department of General Surgery, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - María Achalandabaso
- Department of General Surgery, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Juan Andrés Echeverri
- Department of General Surgery, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Juan Carlos Rodríguez-Sanjuan
- Department of General Surgery, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Marcos López-Hoyos
- Department of Immunology, Marqués de Valdecilla University Hospital, IDIVAL, Transplant and Autoimmunity Research Group, University of Cantabria, Santander, Spain
| | - Javier Crespo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - Emilio Fábrega
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
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Mesa F, Cardona M, Mesa C, Restrepo R, Echeverri JA. Merkel cell carcinoma in the hand. Report of two cases. Case Reports in Plastic Surgery and Hand Surgery 2022; 9:41-45. [PMID: 35083368 PMCID: PMC8786245 DOI: 10.1080/23320885.2021.2025378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Merkel-cell-carcinoma of the hand is rare. The Pathological and Immunohistochemical diagnosis helps us to focus the treatment. Immunotherapy has shown beneficial effects in unresectable/advanced/metastatic stages. The quantification of antibodies against Merkel-cell-polyomavirus (MCPyV) can be a useful for prognosis and follow-up. A wide margin in surgery and the sentinel node are the first option with Radiotherapy.
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Affiliation(s)
- Felipe Mesa
- Titular Professor of Plastic Surgery, CES University, Medellín, Colombia
- Plastic Surgeon IQ interquirofanos, Fundacion Colombiana de Cancerologia, Clinica Vida, Medellin, Colombia
| | - Marcela Cardona
- Dermatology, Universidad Nacional de Colombia, Bogotá, Colombia
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Fernández de Sevilla E, Echeverri JA, Boqué M, Valverde S, Ortega N, Gené A, Rodríguez N, Balibrea JM, Armengol M. Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula. Int J Surg Case Rep 2015; 8C:25-8. [PMID: 25616071 PMCID: PMC4353932 DOI: 10.1016/j.ijscr.2015.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 12/26/2022] Open
Abstract
Primary aorto-enteric fistula is an uncommon life-threating condition. Primary aorto-enteric fistula is usually caused by an untreated abdominal aortic aneurysm. The treatment of choice for aorto-enteric fistula is emergent surgery. High clinical suspicion is essential to make a correct diagnosis of aorto-enteric fistula.
Introduction Primary aorto-enteric fistula (AEF) is an uncommon life-threating condition. Only 4% of them involve the jejunum or ileum and its mortality ranges from 33 to 85%. Presentation of case A 54-year-old female was admitted to the Emergency Department with syncope and hematemesis. The esophagogastroduodenoscopy found a pulsatile vessel in the second portion of the duodenum. A computed tomography scan showed an AEF with an infrarenal aortic aneurysm and iliac artery thrombosis. During surgery, an infrarenal aortic aneurysm complicated with an aorto-jejunal fistula was found. An axilo-bifemoral bypass, open repair of the aneurysm and segmental small bowel resection with primary suture of the jejunal defect were performed. Discussion Depending on previous aortic grafting, AEF can be classified as primary or secondary. Primary AEF is usually caused by an untreated abdominal aortic aneurysm, commonly presenting an infectious etiology. The main clinical sign is a “herald” hemorrhage. The EGD is considered as the first step in diagnosing AEF. The treatment of choice for AEF is emergent surgery. Use of broad-spectrum antibiotics is mandatory in the postoperative period to avoid fistula recurrence. Conclusion AEF is a rare entity with a high mortality. High clinical suspicion is essential to make a correct diagnosis, which is crucial for the prognosis of these patients, such is the case of our patient. If hemodynamic stability is achieved, it allows to employ surgical strategies in which extra-abdominal bypass is performed before fistula is treated.
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Affiliation(s)
- Elena Fernández de Sevilla
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Juan Andrés Echeverri
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Miriam Boqué
- Department of Angiology and Vascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Silvia Valverde
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Nuria Ortega
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Anna Gené
- Department of Angiology and Vascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Nivardo Rodríguez
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - José María Balibrea
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manel Armengol
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Meyers TJ, Smith WR, Ferrari JD, Morgan SJ, Franciose RJ, Echeverri JA. Avulsion of the pubic branch of the inferior epigastric artery: a cause of hemodynamic instability in minimally displaced fractures of the pubic rami. J Trauma 2000; 49:750-3. [PMID: 11038096 DOI: 10.1097/00005373-200010000-00026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T J Meyers
- Department of Orthopaedic Surgery, Denver Health Medical Center, and the University of Colorado School of Medicine, 80204-4507, USA
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Schima W, Saini S, Echeverri JA, Hahn PF, Harisinghani M, Mueller PR. Focal liver lesions: characterization with conventional spin-echo versus fast spin-echo T2-weighted MR imaging. Radiology 1997; 202:389-93. [PMID: 9015063 DOI: 10.1148/radiology.202.2.9015063] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare prospectively the diagnostic accuracy of T2-weighted conventional spin-echo (SE) and fast SE magnetic resonance (MR) imaging for differentiation of benign (hemangiomas or cysts) from malignant (metastases or hepatocellular carcinoma) liver lesions. MATERIALS AND METHODS Fifty-three patients with 55 confirmed liver lesions (20 hemangiomas, eight cysts, 22 metastases, four hepatocellular carcinomas, one malignant fibrous histiocytoma) underwent T2-weighted conventional SE (repetition time msec/echo time [TE] msec = 3,100/ 80,160) and fast SE (5,000-5,000/99-104 [effective TE]) MR imaging at 1.5 T. The images were evaluated quantitatively (lesion-liver signal intensity ratio and lesion T2 index [SIlesion TE80/SIlesion TE160, where SI = signal intensity] and qualitatively (blinded reading) by using receiver operating characteristic analysis. RESULTS Quantitatively, the T2 index (Az = .988) was more accurate than the signal intensity ratio at conventional SE (Az = .920) and fast SE (Az = .910) imaging (P < .05). Qualitatively, there was no statistically significant difference between the blinded reading of conventional SE (Az = .988) and fast SE (Az = .986) images in lesion characterization (benign vs malignant). There was a trend, however, toward superiority of conventional SE imaging for evaluation of "hypervascular" metastases (n = 9). CONCLUSION With the specific parameters used, conventional SE and fast SE images provide equal accuracy for characterization of focal liver lesions. In patients with hypervascular metastases, double-echo conventional SE images may be preferable.
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Affiliation(s)
- W Schima
- Department of Radiology, Massachusetts General Hospital, Boston, USA
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Cotrino Badillo V, Torres-Anjel MJ, Echeverri JA, Peña Beltrán NE. [A new approach to the evaluation of the bactericide potency of chemical desinfectants applied to benzalconium chloride]. Rev Latinoam Microbiol 1977; 18:121-30. [PMID: 267997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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