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Ponce de Leon-Ballesteros G, Pouwels S, Romero-Velez G, Aminian A, Angrisani L, Bhandari M, Brown W, Copaescu C, De Luca M, Fobi M, Ghanem OM, Hasenberg T, Herrera MF, Herrera-Kok JH, Himpens J, Kow L, Kroh M, Kurian M, Musella M, Narwaria M, Noel P, Pantoja JP, Ponce J, Prager G, Ramos A, Ribeiro R, Ruiz-Ucar E, Salminen P, Shikora S, Small P, Stier C, Taha S, Taskin EH, Torres A, Vaz C, Vilallonga R, Verboonen S, Zerrweck C, Zundel N, Parmar C. Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m 2): a Modified Delphi Study. Obes Surg 2024; 34:790-813. [PMID: 38238640 DOI: 10.1007/s11695-023-06990-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. METHODS A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts' votes was achieved. RESULTS A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations. CONCLUSION This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population.
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Affiliation(s)
- Guillermo Ponce de Leon-Ballesteros
- Department of Surgery, Hospital Angeles Morelia, Morelia, Postal: 331, Int. B-502, Av. Montaña Monarca, Montaña Monarca, 58350, Morelia, Michoacan, Mexico.
| | - Sjaak Pouwels
- Department of General, Abdominal Surgery and Coloproctology, Helios St. Elisabeth Hospital, Oberhausen, NRW, Germany
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luigi Angrisani
- Department of Public Health, Federico II" University of Naples, Naples, Italy
| | | | - Wendy Brown
- Department of Surgery, Monash University, Melbourne, Australia
| | - Catalin Copaescu
- Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania
| | | | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Till Hasenberg
- Helios Obesity Center West, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Miguel F Herrera
- Clinic for Nutrition and Obesity, The American British Cowdray Medical Center Observatorio, Mexico City, Mexico
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Johnn H Herrera-Kok
- Department of General and Digestive Surgery, University Hospital of Leon, Leon, Spain
| | - Jacques Himpens
- Bariatric Surgery Unit, Delta CHIREC Hospital, Brussels, Belgium
| | - Lilian Kow
- Flinders Medical Centre, Adelaide, Australia
| | - Matthew Kroh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mario Musella
- Advanced Biomedical Sciences Department, "Federico II" University of Naples, Naples, Italy
| | | | - Patrick Noel
- Clinique Bouchard, ELSAN, Marseille, France
- Emirates Specialty Hospital, DHCC, Dubai, UAE
| | - Juan P Pantoja
- Department of Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jaime Ponce
- CHI Memorial Hospital Chattanooga, Chattanooga, TN, USA
| | - Gerhard Prager
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Rui Ribeiro
- Department of General Surgery, Hospital Lusiadas Amadora, Amadora, Portugal
| | - Elena Ruiz-Ucar
- Department of Bariatric and Endocrine Surgery, Fuenlabrada University Hospital, Madrid, Spain
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Scott Shikora
- Department of Surgery, Division of Gastrointestinal and General Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter Small
- Directorate of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Christine Stier
- Department of Interdisciplinary Endoscopy and Visceral Surgery, University Hospital Mannheim, Mannheim, Germany
| | - Safwan Taha
- Bariatric and Metabolic Surgery Center, Mediclinic Hospital Airport Road, Abu Dhabi, UAE
| | - Eren Halit Taskin
- Department of Surgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Antonio Torres
- General and Digestive Surgery Service, Department of Surgery, Hospital Clínico San Carlos, Complutense University Medical School, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain
| | - Carlos Vaz
- Obesity and Metabolic Surgery Unit, Hospital CUF Tejo, Lisbon, Portugal
| | - Ramon Vilallonga
- Department of Surgery, Enodcrine-Metabolic and Bariatric Surgery Unit, Vall Hebron Barcelona Hospital Campus, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Carlos Zerrweck
- The American British Cowdray Medical Center Santa Fe, Mexico City, Mexico
| | - Natan Zundel
- Department of Surgery, University of Buffalo, Buffalo, NY, USA
| | - Chetan Parmar
- Department of Surgery, The Whittington Hospital NHS Trust, London, UK
- Apollo Hospitals Educational and Research Foundation, Hyderabad, India
- University College London, London, UK
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Othman W, Vandyck KE, Abril C, Barajas-Gamboa JS, Pantoja JP, Kroh M, Qasaimeh MA. Stiffness Assessment and Lump Detection in Minimally Invasive Surgery Using In-House Developed Smart Laparoscopic Forceps. IEEE J Transl Eng Health Med 2022; 10:2500410. [PMID: 35774413 PMCID: PMC9216325 DOI: 10.1109/jtehm.2022.3180937] [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] [Received: 02/04/2022] [Revised: 05/01/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
Abstract
Minimally invasive surgery (MIS) incorporates surgical instruments through small incisions to perform procedures. Despite the potential advantages of MIS, the lack of tactile sensation and haptic feedback due to the indirect contact between the surgeon’s hands and the tissues restricts sensing the strength of applied forces or obtaining information about the biomechanical properties of tissues under operation. Accordingly, there is a crucial need for intelligent systems to provide an artificial tactile sensation to MIS surgeons and trainees. This study evaluates the potential of our proposed real-time grasping forces and deformation angles feedback to assist surgeons in detecting tissues’ stiffness. A prototype was developed using a standard laparoscopic grasper integrated with a force-sensitive resistor on one grasping jaw and a tunneling magneto-resistor on the handle’s joint to measure the grasping force and the jaws’ opening angle, respectively. The sensors’ data are analyzed using a microcontroller, and the output is displayed on a small screen and saved to a log file. This integrated system was evaluated by running multiple grasp-release tests using both elastomeric and biological tissue samples, in which the average force-to-angle-change ratio precisely resembled the stiffness of grasped samples. Another feature is the detection of hidden lumps by palpation, looking for sudden variations in the measured stiffness. In experiments, the real-time grasping feedback helped enhance the surgeons’ sorting accuracy of testing models based on their stiffness. The developed tool demonstrated a great potential for low-cost tactile sensing in MIS procedures, with room for future improvements. Significance: The proposed method can contribute to MIS by assessing stiffness, detecting hidden lumps, preventing excessive forces during operation, and reducing the learning curve for trainees.
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Affiliation(s)
- Wael Othman
- Engineering Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Kojo E. Vandyck
- Engineering Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Carlos Abril
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Digestive Disease Institute, Abu Dhabi, United Arab Emirates
| | - Juan S. Barajas-Gamboa
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Digestive Disease Institute, Abu Dhabi, United Arab Emirates
| | - Juan P. Pantoja
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Digestive Disease Institute, Abu Dhabi, United Arab Emirates
| | - Matthew Kroh
- Department of General Surgery, Cleveland Clinic Ohio, Digestive Disease and Surgery Institute, Cleveland, OH, USA
| | - Mohammad A. Qasaimeh
- Engineering Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
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Morales-Maza J, Rodríguez-Quintero JH, Santes O, Hernández-Villegas AC, Clemente-Gutiérrez U, Sánchez-Morales GE, Mier Y Terán-Ellis S, Pantoja JP, Mercado MA. Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review. Rev Gastroenterol Mex (Engl Ed) 2019; 84:482-491. [PMID: 31521405 DOI: 10.1016/j.rgmx.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 01/04/2023]
Abstract
Acute cholecystitis is one of the most frequent diseases faced by the general surgeon. In recent decades, different prognostic factors have been observed, and effective treatments described, to improve the results in patients with said pathology (lower morbidity and mortality, shorter hospital stay, and minimum conversion of laparoscopic to open procedures). In general, laparoscopic cholecystectomy is the standard treatment for acute cholecystitis, but it is not exempt from complications, especially in patients with numerous comorbidities or those that are critically ill. Percutaneous cholecystostomy emerged as a less invasive alternative for the treatment of acute cholecystitis in patients with organ failure or a prohibitive surgical risk. Even though it is an effective procedure, its usefulness and precise indications are subjects of debate. In addition, there is little evidence on cholecystostomy catheter management. We carried out a review of the literature covering the main aspects physicians involved in the management of acute cholecystitis should be familiar with.
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Affiliation(s)
- J Morales-Maza
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - J H Rodríguez-Quintero
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - O Santes
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - A C Hernández-Villegas
- Departamento de Radiología Intervencionista, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - U Clemente-Gutiérrez
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - G E Sánchez-Morales
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - S Mier Y Terán-Ellis
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - J P Pantoja
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - M A Mercado
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Ciudad de México, México.
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Chávez KV, Barajas EM, Soroa F, Gamboa-Dominguez A, Ordóñez S, Pantoja JP, Sierra M, Velázquez-Fernández D, Herrera MF. Safety assessment of the use of ultrasonic energy in the proximity of the recurrent laryngeal nerve in a porcine model. Am J Surg 2017. [PMID: 28622836 DOI: 10.1016/j.amjsurg.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Advanced bipolar and ultrasonic energy have demonstrated reduction of operating time and blood loss in thyroidectomy. However, these devices generate heat and thermal dispersion that may damage adjacent structures such as the recurrent laryngeal nerve (RLN). This study was designed to evaluate the safety profile of the Harmonic Focus+® (HF+) device through the evaluation of thermal injury to the RLN using different algorithms of distance and time with state of the art technology. METHODS 25 Vietnamese pigs underwent activation of HF+ in the proximity of their RLN. They were divided into 4 groups according to activation distance (3 mm, 2 mm, 1 mm and on the RLN). Time of activation, time between tones of the ultrasonic generator, changes in the electromyographic signal using continuous nerve neuromonitoring, vocal fold mobility assessed by direct laryngoscopy and histological thermal damaged were evaluated. RESULTS None of the pigs had loss of signal in the electromyography during the procedure; only one pig had isolated transient decrease in amplitude and one increase in latency. One pig had transient vocal fold paresis in the group with activation on the nerve. Evaluation of the nerves by histology and immunohistochemistry did not show significant changes attributed to thermal injury. CONCLUSIONS The use of ultrasonic energy close to the RLN is safe, provided that activation time does not exceed the necessary time to safely transect the tissue.
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Affiliation(s)
- Karla V Chávez
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Elpidio M Barajas
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francisco Soroa
- Service of Otolaryngology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Armando Gamboa-Dominguez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Samuel Ordóñez
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan P Pantoja
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mauricio Sierra
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - David Velázquez-Fernández
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Miguel F Herrera
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Shikora SA, Toouli J, Herrera MF, Kulseng B, Brancatisano R, Kow L, Pantoja JP, Johnsen G, Brancatisano A, Tweden KS, Knudson MB, Billington CJ, Billingto CJ. Intermittent Vagal Nerve Block for Improvements in Obesity, Cardiovascular Risk Factors, and Glycemic Control in Patients with Type 2 Diabetes Mellitus: 2-Year Results of the VBLOC DM2 Study. Obes Surg 2016; 26:1021-8. [PMID: 26471783 DOI: 10.1007/s11695-015-1914-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND One-year results of the VBLOC DM2 study found that intermittent vagal blocking (VBLOC therapy) was safe among subjects with obesity and type 2 diabetes mellitus (T2DM) and led to significant weight loss and improvements in glycemic parameters and cardiovascular risk factors. Longer-term data are needed to determine whether the results are sustained. METHODS VBLOC DM2 is a prospective, observational study of 28 subjects with T2DM and body mass index (BMI) between 30 and 40 kg/m(2) to assess mid-term safety and weight loss and improvements in glycemic parameters, and other cardiovascular risk factors with VBLOC therapy. Continuous outcome variables are reported using mixed models. RESULTS At 24 months, the mean percentage of excess weight loss was 22% (95% CI, 15 to 28, p < 0.0001) or 7.0% total body weight loss (95% CI, 5.0 to 9.0, p < 0.0001). Hemoglobin A1c decreased by 0.6 percentage points (95% CI, 0.2 to 1.0, p = 0.0026) on average from 7.8% at baseline. Fasting plasma glucose declined by 15 mg/dL (95% CI, 0 to 29, p = 0.0564) on average from 151 mg/dL at baseline. Among subjects who were hypertensive at baseline, systolic blood pressure declined 10 mmHg (95% CI, 2 to 19, p = 0.02), diastolic blood pressure declined by 6 mmHg (95% CI, 0 to 12, p = 0.0423), and mean arterial pressure declined 7 mmHg (95% CI, 2 to 13, p = 0.014). Waist circumference was significantly reduced by 7 cm (95% CI, 4 to 10, p < 0.0001) from a baseline of 120 cm. The most common adverse events were mild or moderate heartburn, implant site pain, and constipation. CONCLUSIONS Improvements in obesity and glycemic control were largely sustained after 2 years of treatment with VBLOC therapy with a well-tolerated risk profile.
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Affiliation(s)
- Scott A Shikora
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,EnteroMedics Inc, 2800 Patton Road, St. Paul, MN, 55113, USA.
| | - James Toouli
- Adelaide Bariatric Center, Flinders Private Hospital, Suite 502/Level 5, Bedford Park, SA, 5041, Australia
| | - Miguel F Herrera
- Instituto Nacional de al Nutricion, Salvador Zubrian (INNSZ), Vasco de Quiroga 15, Tlalpan, 1400, Mexico City, DF, Mexico
| | - Bård Kulseng
- Center for Obesity, St. Olavs Hospital, Olav Kyrres Gate 6, 7006, Trondheim, Norway
| | - Roy Brancatisano
- Institute of Weight Control, 495 Windsor Road, Baulkham Hills, NSW, 2153, Australia
| | - Lilian Kow
- Adelaide Bariatric Center, Flinders Private Hospital, Suite 502/Level 5, Bedford Park, SA, 5041, Australia
| | - Juan P Pantoja
- Instituto Nacional de al Nutricion, Salvador Zubrian (INNSZ), Vasco de Quiroga 15, Tlalpan, 1400, Mexico City, DF, Mexico
| | - Gjermund Johnsen
- Center for Obesity, St. Olavs Hospital, Olav Kyrres Gate 6, 7006, Trondheim, Norway
| | - Anthony Brancatisano
- Institute of Weight Control, 495 Windsor Road, Baulkham Hills, NSW, 2153, Australia
| | | | - Mark B Knudson
- EnteroMedics Inc, 2800 Patton Road, St. Paul, MN, 55113, USA
| | - Charles J Billington
- University of Minnesota, Minneapolis, Minnesota Veterans' Administration Medical Center, One Veterans' Drive, Minneapolis, MN, 55417, USA
| | - Charles J Billingto
- University of Minnesota, Minneapolis, Minnesota Veterans' Administration Medical Center, One Veterans' Drive, Minneapolis, MN, 55417, USA
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Tweden K, F Herrera M, Toouli J, Kulseng B, Brancatisano R, Kow L, P Pantoja J, Johnsen G, Brancatisano A, J Waataja J, J Billington C, A Shikora S. Vagal Nerve Block for Improvements in Glycemic Control in Obese Patients with Type 2 Diabetes Mellitus: Three-Year Results of the VBLOC DM2 Study. ACTA ACUST UNITED AC 2016. [DOI: 10.15436/2376-0494.17.1250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Montalvo J, Velazquez D, Pantoja JP, Sierra M, López-Karpovitch X, Herrera MF. Laparoscopic splenectomy for primary immune thrombocytopenia: clinical outcome and prognostic factors. J Laparoendosc Adv Surg Tech A 2014; 24:466-70. [PMID: 24905792 DOI: 10.1089/lap.2013.0267] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is considered the standard treatment for patients with refractory primary immune thrombocytopenia (ITP). PATIENTS AND METHODS All patients with ITP who underwent LS during the last 17 years and who had a minimum follow-up of 1 year were included. Several perioperative variables such as age, platelet count, and duration of preoperative therapy were recorded and analyzed, looking for potential predictive variables of clinical response. RESULTS In total, 150 patients were included: 108 (72%) women and 42 (28%) men, with a mean age of 37.3±15.8 years. In the evaluation 1 year after surgery, 133 (88.7%) patients had achieved complete response, 4 (2.7%) had a response, and in 13 (8.6%) there was no response. None of the analyzed preoperative variables was identified as a predictive factor of response at 1 year. Immediate responders after surgery (≥150,000 platelets/mL during the first week) had a higher platelet count and rate of complete response at 1 year (94.2%). CONCLUSIONS LS has a high success rate in patients with refractory ITP. Potential predictive indicators of success remain to be determined.
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Affiliation(s)
- Jorge Montalvo
- 1 Department of Surgery, "Salvador Zubirán" National Institute of Medical Sciences and Nutrition , Mexico City, Mexico
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Camilleri M, Toouli J, Herrera MF, Kulseng B, Kow L, Pantoja JP, Marvik R, Johnsen G, Billington CJ, Moody FG, Knudson MB, Tweden KS, Vollmer M, Wilson RR, Anvari M. Intra-abdominal vagal blocking (VBLOC therapy): clinical results with a new implantable medical device. Surgery 2008; 143:723-31. [PMID: 18549888 DOI: 10.1016/j.surg.2008.03.015] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 03/14/2008] [Indexed: 12/20/2022]
Abstract
BACKGROUND A new medical device uses high-frequency electrical algorithms to create intermittent vagal blocking (VBLOC therapy). The aim is to assess the effects of vagal blocking on excess weight loss (EWL), safety, dietary intake, and vagal function. METHODS An open-label, 3-center study was conducted in obese subjects (body mass index [BMI] 35-50 kg/m(2)). Electrodes were implanted laparoscopically on both vagi near the esophagogastric junction to provide electrical block. Patients were followed for 6 months for body weight, safety, electrocardiogram, dietary intake, satiation, satiety, and plasma pancreatic polypeptide (PP) response to sham feeding. To specifically assess device effects alone, no diet or exercise programs were instituted. RESULTS Thirty-one patients (mean BMI, 41.2 +/- 1.4 kg/m(2)) received the device. Mean EWL at 4 and 12 weeks and 6 months after implant was 7.5%, 11.6%, and 14.2%, respectively (all P < .001); 25% of patients lost >25% EWL at 6 months (maximum, 36.8%). There were no deaths or device-related serious adverse events (AEs). Calorie intake decreased by >30% at 4 and 12 weeks and 6 months (all P <or= .01), with earlier satiation (P < .001) and reduced hunger (P = .005). After 12 weeks, plasma PP responses were suppressed (20 +/- 7 vs 42 +/- 19 pg/mL). Average percent EWL in patients with PP response <25 pg/mL was double that with PP response >25 pg/mL (P = .02). Three patients had serious AEs that required brief hospitalization, 1 each for lower respiratory tract, subcutaneous implant site seroma, and Clostridium difficile diarrhea. CONCLUSIONS Intermittent, intra-abdominal vagal blocking is associated with significant EWL and a desirable safety profile.
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Gil-Cárdenas A, Cordón C, Gamino R, Rull JA, Gómez-Pérez F, Pantoja JP, Herrera MF. Laparoscopic adrenalectomy: lessons learned from an initial series of 100 patients. Surg Endosc 2007; 22:991-4. [PMID: 17705066 DOI: 10.1007/s00464-007-9556-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 10/25/2006] [Accepted: 12/04/2006] [Indexed: 01/28/2023]
Abstract
BACKGROUND Laparoscopic adrenalectomy is considered the gold standard for the surgical treatment of adrenal disorders in most centers. This study analyzes the authors' experience using the lateral intraperitoneal approach with the first 100 patients. In addition to analyzing the authors' experience, this article aims to contrast it with some published series as an internal quality control. METHODS In a 10-year period, 138 laparoscopic adrenalectomies were performed for 100 patients. Demographics, surgical results, complications, and long-term outcomes were analyzed. RESULTS The participants comprised 69 women and 31 men with a mean age of 37 years. The procedures included 24 right, 38 left, and 38 bilateral adrenalectomies. The indications for surgery were Cushing's disease for 33 patients, pheochromocytoma (4 bilateral) for 23 patients, Cushing's syndrome for 18 patients, Conn's syndrome for 16 patients, and incidentaloma for 10 patients. Five procedures were converted to open surgery. Two patients with pheochromocytoma required intraoperative blood transfusion. The mean operative time was 174 min for unilateral adrenalectomies and 302 min for the bilateral procedures. The mean hospital stay was 5 days. Surgical morbidity included an abdominal wall hematoma, a small pneumothorax, and intraabominal bleeding in one patient that required reexploration. There were three operative mortalities not related to the technique. The long-term results showed control of hypercortisolism in all the patients with Cushing's disease and 82% of the patients with pheochromocytoma. Most of the patients with Conn's syndrome (91.4%) became normotensive after surgery. CONCLUSIONS Laparoscopic adrenalectomy is safe and effective. The complications are mild, and mortality is related more to the patient's condition than to the surgical technique.
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Affiliation(s)
- A Gil-Cárdenas
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Arceo-Olaiz R, Montalvo J, España N, Garcia-Garcia E, Velazquez-Fernandez D, Pantoja JP, Herrera MF. 37. Surg Obes Relat Dis 2007. [DOI: 10.1016/j.soard.2007.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Orozco H, Arch J, Medina-Franco H, Pantoja JP, González QH, Vilatoba M, Hinojosa C, Vargas-Vorackova F, Sifuentes-Osornio J. Molgramostim (GM-CSF) associated with antibiotic treatment in nontraumatic abdominal sepsis: a randomized, double-blind, placebo-controlled clinical trial. Arch Surg 2006; 141:150-3; discussion 154. [PMID: 16490891 DOI: 10.1001/archsurg.141.2.150] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS The addition of molgramostim (recombinant human granulocyte-macrophage colony-stimulating factor) to antibiotic therapy for nontraumatic and generalized abdominal sepsis is effective and has a significant impact on length of hospitalization, direct medical costs, and mortality. DESIGN Randomized, double-blind, placebo-controlled clinical trial. SETTING Tertiary referral center. PATIENTS Fifty-eight patients with abdominal sepsis. INTERVENTIONS Patients were allocated to receive, in addition to ceftriaxone sodium, amikacin sulfate, and metronidazole, molgramostim in a daily dosage of 3 microg/kg for 4 days (group 1) or placebo (group 2). Antibiotics were administered for at least 5 days and discontinued after clinical improvement had occurred and white blood cell count had been normal for 48 hours. MAIN OUTCOME MEASURES Time to improvement, duration of antibiotic therapy, hospital stay, complications, mortality, and adverse reactions to drugs. RESULTS Median time to improvement was 2 days in group 1 and 4 days in group 2 (P<.005). Median length of hospitalization was 9 and 13 days, respectively (P<.001), and median duration of antibiotic therapy was 9 and 13 days, respectively (P<.001). Numbers of infectious complications in the 2 groups were, respectively, 6 and 16 (P = .02); of residual abscesses, 3 and 5; and of deaths, 2 and 2. Costs per patient were 12,333 dollars and 16,081 dollars (US dollars), respectively. CONCLUSION Addition of molgramostim to antibiotic therapy reduces the rate of infectious complications, the length of hospitalization, and costs in patients with nontraumatic abdominal sepsis.
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Affiliation(s)
- Héctor Orozco
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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12
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Fernández-Cruz L, Sáenz A, Astudillo E, Martinez I, Hoyos S, Pantoja JP, Navarro S. Outcome of laparoscopic pancreatic surgery: endocrine and nonendocrine tumors. World J Surg 2002; 26:1057-65. [PMID: 12016486 DOI: 10.1007/s00268-002-6673-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [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: 12/14/2022]
Abstract
Laparoscopic pancreatic surgery (LapPS) for management of benign pancreatic tumors has still not been defined. This paper evaluates the feasibility and outcome of LapPS in patients with endocrine pancreatic tumors (EPTs) and cystic neoplasms of the pancreas (CyNP). Eighteen patients with benign pancreatic tumors underwent LapPS between January 1998 and May 2001. The indications were 10 EPTs (6 sporadic insulinomas, 1 multiple insulinoma of multiple endocrine neoplasia type 1, 2 nonfunctioning tumors, 1 VIPoma) and 8 CyNPs (3 serous cystadenomas, 5 mucinous cystic neoplasms). The laparoscopic procedure was performed using four ports with patients in the half-lateral position. Laparoscopic ultrasonography (LapUS) was used in all cases. Laparoscopic enucleation (LapE) was planned in five patients and performed in four (one conversion for tumor not found during laparoscopy). Laparoscopic pancreatic resection (LapPR) with spleen salvage was planned in 13 patients and performed in 12 (one conversion for metastatic VIPoma), with splenic vessel preservation in 11 patients and short gastric vessel preservation in 1. The average operating time was 3.5 hours after enucleation, 4.0 hours after distal pancreatectomy, and 5.0 hours after subtotal pancreatectomy. Pancreatic fistula was observed in two patients after LapE and in three patients after LapPR. Splenectomy for splenic abscess was performed 1 week after surgery in a patient with short gastric vessel splenic preservation. The average hospital stay was 5 days. We concluded that LapPS is a safe method for removing EPTs and CyNPs, although the incidence of pancreatic fistulas remains high. In selected patients LapPS offers significant benefit to patients: reduced trauma to the abdominal wall, short hospital stay, and a quick postoperative recovery.
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Affiliation(s)
- L Fernández-Cruz
- Department of Surgery, Institute of Digestive Diseases IMD, Hospital Clinic, University of Barcelona, Villarroel, 170, Scalera 6, 4th Floor, Spain.
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Fernández-Cruz L, Sáenz A, Astudillo E, Pantoja JP, Uzcátegui E, Navarro S. Laparoscopic pancreatic surgery in patients with chronic pancreatitis. Surg Endosc 2002; 16:996-1003. [PMID: 12163971 DOI: 10.1007/s00464-001-9065-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2001] [Accepted: 11/08/2001] [Indexed: 01/12/2023]
Abstract
BACKGROUND In recent years, technological advances and technical refinements to laparoscopic instruments have encouraged some surgeons to explore the application of laparoscopic methods to benign disorders of the pancreas. The aim of this report was to evaluate the feasibility and outcome of laparoscopic pancreatic surgery in patients with chronic pancreatitis. METHODS One group of five patients with disease of nonalcoholic origin localized in the body-tail of the pancreas underwent distal pancreatectomy with preservation of the splenic vessels; a second group of six patients with symptomatic pancreatic pseudocysts (alcoholic origin in four cases and idiopathic in two cases) underwent laparoscopic transgastric drainage. For distal pancreatectomy and spleen salvage, the patient's positioning was half-lateral decubitus with the left side up. Four ports were used. A comparison was made with 41 patients with chronic, pancreatitis who underwent conventional open distal pancreatectomy. For the patients with laparoscopic distal pancreatectomy, the mean operative time was 4 h (range 3-5). RESULTS There were no pancreatic-related complications, but one patient was reoperated for perforation of duodenal ulcer. The mean hospital stay was 6 days and the mean time to resume normal daily activities was 3 weeks. Laparoscopic pseudocyst drainage was performed in four patients via laparoscopic anterior gastrostomy and two patients via laparoscopic intraluminal cystogastrostomy. The mean operative time was 100 min (range 60-160). There was no morbidity. The mean hospital stay was 5 days, and the mean time to resume normal daily activities was 2 weeks. CONCLUSION This study provides information about the possibilities of performing laparoscopic surgery in patients with chronic pancreatitis. Laparoscopic distal pancreatectomy with preservation of the splenic vessels and laparoscopic transgastric drainage are feasible and safe techniques. They offer obvious advantages, such as reduction of the parietal damage to the abdomen, a shorter hospital stay, and an earlier postoperative recovery than can be obtained with conventional open pancreatic resection.
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Affiliation(s)
- L Fernández-Cruz
- Department of Surgery, Institute of Digestive Diseases IMD, Hospital Clinic, University of Barcelona, Villarroel 170, Escalera 6, Barcelona E-08034, Spain.
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Fernández-Cruz L, Herrera M, Sáenz A, Pantoja JP, Astudillo E, Sierra M. Laparoscopic pancreatic surgery in patients with neuroendocrine tumours: indications and limits. Best Pract Res Clin Endocrinol Metab 2001; 15:161-75. [PMID: 11472032 DOI: 10.1053/beem.2001.0133] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Laparoscopic pancreatic procedures are still at an evaluation stage with regard to their indications and techniques. Between January 1998 and December 2000, 13 patients with endocrine pancreatic tumours - 11 insulinomas and 2 non-functioning tumours-underwent laparoscopic surgery, laparoscopic ultrasonography being used in all the patients. Enucleation was performed in five patients. The operative time was 2-3 hours. Distal pancreatectomy was performed in six patients with insulinomas, and spleen preservation with intact splenic vessels was feasible in five. Splenectomy was necessary in one patient for technical reasons. Laparoscopic distal pancreatectomy with splenic vessel preservation was performed in two patients with a large (6 and 8 cm) non-functioning tumour. The mean operative time for all the patients undergoing distal pancreatectomy was 4 hours, ranging from 3 to 5 hours. A pancreatic fistula occurred in three patients after tumour enucleation and in two patients after distal pancreatectomy; the mean hospital stay for all patients was 5 days. Enucleation guided by laparoscopic ultrasonography thus allows safe tumour dissection and excision, laparoscopic distal pancreatectomy also being feasible and safe. Splenic salvage with splenic vessel preservation is technically possible. The laparoscopic approach allows a shorter hospital stay and an earlier return to normal activities.
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Affiliation(s)
- L Fernández-Cruz
- Department of Surgery, Institute of Digestive Diseases IMD, Hospital Clinic, University of Barcelona, Spain
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Abstract
BACKGROUND Adrenalectomy in Cushing's syndrome and disease involves particular risks and complications. The aim of the study was to compare the open posterior and the flank laparoscopic approaches in this group of patients. METHODS Forty patients who underwent unilateral or bilateral adrenalectomy for hypercortisolism between 1991 and 1999 were studied. Patients were divided as follows: adenoma--5 laparoscopic and 6 open; hyperplasia--17 laparoscopic and 12 open. Demographics, surgical details, outcome, and complications were comparatively analyzed. RESULTS Patients undergoing laparoscopic or open adrenalectomy were comparable in terms of age, sex distribution, body mass index, respiratory status, and anesthetic risk. Operative time was longer in the laparoscopic group. One patient in the laparoscopic group died of upper gastrointestinal tract bleeding on postoperative day 17. Two patients in the open group and one in the laparoscopic group experienced postoperative complications. Cure of the disease occurred in all patients. Mild abdominal wall pain developed in one patient in each group. No abdominal wall weakness was identified in either group. CONCLUSIONS Cure rate and operative and long-term morbidity were similar for laparoscopic and open adrenalectomies in this series. However, it is important to emphasize that late complications in our patients who underwent the posterior open procedure were rather infrequent.
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Affiliation(s)
- E Acosta
- Department of Surgery, Instituto Nacional de la Nutrición Salvador Zubirán, Tlalpan, México
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Mercado MA, Orozco H, Vasquez M, Pantoja JP, Contreras A, Catzin-Kuhlmann A, Flores A, Rodriguez-Davalos M. Comparative study of 2 variants of a modified esophageal transection in the Sugiura-Futagawa operation. Arch Surg 1998; 133:1046-9. [PMID: 9790199 DOI: 10.1001/archsurg.133.10.1046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare 2 techniques of esophageal transection in our modification of the Sugiura-Futagawa procedure for the treatment of bleeding portal hypertension in low-risk patients who cannot undergo surgery to have shunts placed. DESIGN A prospective controlled trial comparing 2 variants of transection (classic, complete section of the anterior muscularis externa and whole mucosa; modified, placement of a circumferential running suture without opening the mucosa). SETTING Academic university hospital. PATIENTS Eighty-three low-risk patients (Child-Pugh score A and B) with a history of bleeding portal hypertension were operated on (35 classic, 48 modified transections) between 1989 and 1996. Both groups were comparable. MAIN OUTCOME MEASURES Postoperative dehiscence of the transection was evaluated as well as fistulization, postoperative stenosis, rebleeding, postoperative endoscopic findings, survival, and mortality. RESULTS Fistulization was observed in 1 (2%) of the patients in the modified group, and dehiscence in 1 patient (2%). In the classic group, 3 (8%) of the patients had dehiscence (relative risk, 2.6) and 1 (2%) of the patients, fistulization. No differences were observed regarding rebleeding (6 patients [6%] vs 5 patients [7%]), postoperative stenosis (4 patients [8%] vs 5 patients [10%]), postoperative endoscopic findings, survival, and mortality (early and late). CONCLUSION The modified variant of the transection has a lower frequency of postoperative dehiscence, with the same long-term results.
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Affiliation(s)
- M A Mercado
- Portal Hypertension Clinic, Instituto Nacional de la Nutricion Salvador Zubiran, Mexico City, Mexico
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Orozco H, Mercado MA, Martinez R, Tielve M, Chan C, Vasquez M, Zenteno-Guichard G, Pantoja JP. Is splenectomy necessary in devascularization procedures for treatment of bleeding portal hypertension? Arch Surg 1998; 133:36-8. [PMID: 9438756 DOI: 10.1001/archsurg.133.1.36] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate whether splenectomy as a part of devascularization procedures is necessary. DESIGN Prospective, controlled, randomized trial. SETTING University hospital, referral center. PATIENTS A total of 55 patients (Child-Pugh class A and B) with a history of bleeding portal hypertension were treated by means of a modified Sugiura-Futagawa procedure. Twenty-three patients underwent splenectomy and 22 did not. METHODS Postoperative outcome was recorded and comparison of the 2 groups was done with the Fisher exact test. Kaplan-Meier survival curves were constructed. Main outcome and postoperative differences between the patients who underwent splenectomy and those who did not were investigated. RESULTS Both groups were comparable in the postoperative period. Significant differences were observed in transfusion requirements and postoperative portal vein thrombosis, both favoring the group without splenectomy. No differences in rebleeding, encephalopathy rate, operative time, or postoperative complications were observed. CONCLUSION Splenectomy is not routinely necessary in devascularization procedures for bleeding portal hypertension.
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Affiliation(s)
- H Orozco
- Portal Hypertension Clinic, Instituto Nacional de la Nutricion, Salvador Zubiran, Mexico City, Mexico
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Rodríguez-Sancho LC, Pantoja JP, Gamino R, Reza A, Rull JA, Herrera MF. The first 50 cases of primary hyperparathyroidism treated by an endocrine surgery team. Rev Invest Clin 1997; 49:179-82. [PMID: 9294960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary hyperparathyroidism (HPT) is a common endocrine disease treated very effectively by surgery. There have been changes in the management of parathyroid surgery in our hospital: since 1991, all patients have been treated by a service of endocrine surgery. OBJECTIVE To analyze the outcome of the first 50 patients treated in the endocrine surgery service. METHODS A prospective analysis of clinical characteristics, laboratory studies, intraoperative findings, surgical complications and outcome of 50 patients with primary HPT seen between July 1991 and March 1994 was performed. RESULTS Ten patients were male and 40 female with a mean age of 53 years. A parathyroid adenoma was found in 43 patients, a parathyroid hyperplasia in five, a double adenoma in one and an adenoma in a supernumerary gland in one patient. Surgical cure of the disease was achieved in 96% of the patients after one surgical procedure and in 100% during the same hospital stay after repeat cervical exploration. CONCLUSIONS Our results support the use of surgical cervical exploration in the treatment of primary HPT.
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Affiliation(s)
- L C Rodríguez-Sancho
- Department of Surgery, Instituto Nacional de la Nutrición Salvador Zubiran, Mexico City
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Lemme EM, Almeida SM, Firman CM, Pantoja JP, Nascimento FA. [Prolonged esophageal pH monitoring. Evaluation of 170 tests]. Arq Gastroenterol 1997; 34:71-7. [PMID: 9496421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The authors present the experience from a university service of 170 outpatients submitted to 24-hour esophageal pH recording. Indications were: typical symptoms such as heartburn (67 patients), with and without endoscopic esophagitis, chest pain (65 patients; 40% had normal coronariography), a select group with dysphagia (28), besides eight asthmatics, one chronic intractable hiccups, and one esophageal ulcer. There was abnormal reflux in 47% of the total group. pH recording showed abnormal results in 86% of patients presenting heartburn and esophagitis and in 50% of patients without esophagitis. In the chest pain group, 37% had abnormal reflux, but pain with reflux episode could be observed only in 1/5 of them. Twenty percent of dysphagia patients had pathologic reflux and 50% among asthmactics, but the number of patients is small. Authors emphasize the importance of pHmetry as a diagnostic tool and suggest that it is important the knowledge of reflux pattern in healthy Brazilian people.
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Affiliation(s)
- E M Lemme
- Serviço de Gastroenterologia do Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro-HUCFF-UFRJ
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Rojas G, Hernández Pando R, Farias L, Romo L, Contreras JL, Rodriguez LC, Pantoja JP, Díliz HS. Effect of initial perfusion with lactated Ringer's solution in 24-hour canine liver preservation with University of Wisconsin solution. Transplant Proc 1992; 24:1981-3. [PMID: 1412937] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- G Rojas
- Department of Transplant, Instituto Nacional de la Nutrición Salvador Zubiran, Mexico City, Mexico
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Díliz H, Bordes J, Contreras JL, Rojas G, Pantoja JP, de Leo C, Dib A. Enhancement of organ procurement by the National Program of Cadaveric Organ Transplantation in Mexico. Transplant Proc 1992; 24:2054-5. [PMID: 1412972] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- H Díliz
- Department of Transplants, Instituto Nacional de la Nutrición Salvador Zubirán, Tlálpan, Mexico
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Díliz H, Mercado MA, Rojas G, Contreras JL, Farias L, Romo L, Pantoja JP, Orozco H. New technique for veno-venous bypass in a canine liver transplant model. Transplant Proc 1992; 24:1987-8. [PMID: 1412940] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- H Díliz
- Department of Transplantation, Instituto Nacional de la Nutrición Salvador Zubirán, México D.F
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Pantoja JP, Fink JL. More women in pharmacy. Students' views on the matter. Am Pharm 1985; NS25:54-8. [PMID: 4091156] [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: 01/08/2023]
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