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J Alvarez-Cienfuegos

Publications and source records attributed to J Alvarez-Cienfuegos.

13 recordsLinked to original sources
PubMed2006

Risk factors related to operative morbidity in patients undergoing gastrectomy for gastric cancer.

INTRODUCTION: The purpose of this study is to analyze postoperative morbidity and mortality of patients operated on for gastric cancer in a single institution during the last twenty years, and to define risk factors for complications. MATERIAL AND METHODS: A retrospective study was carried out on 434 patients who underwent gastrectomy for gastric cancer between January 1983 and December 2002. Analysis of main medical and surgical complications and analysis of morbidity risk factors. RESULTS: Overall morbidity and mortality rates were 38.4% and 2.7% respectively. The most frequent complications were pneumonia (13%) and intra-abdominal abcesses (12%). The main cause of death was anastomotic dehiscence with abdominal sepsis. The last ten years mortality rate dropped from 4.7% to 0.8%. Risk factors for complications were gender (male, p = 0.01) and resection of spleen (p = 0.02) or pancreas (p = 0.002). A significantly lesser rate of complications was found in patients who had underwent gastrectomy during the previous five years (p = 0.001) or with tumors located in the lower third of the stomach (p = 0,01). CONCLUSION: Morbidity of gastrectomy for gastric cancer in our institution is still high but mortality has decreased significantly over the last ten years due to the specialization of the hospital and the surgical team. The main risk factor for complications was pancreatosplenectomy in the multivariate analysis.

Abdominal Abscess↗
PubMed1998

Liver transplantation in cirrhotic patients over 60 years of age.

Although life expectancy in Spain is above seventy years, age over sixty is considered a relative contraindication for liver transplantation (LT) in most centers. The aim of this study was to assess the outcome of LT in patients over sixty years of age comparing them to patients under that age. From January 1992 to August 1995, 61 cirrhotic patients underwent LT at our institution; of them, 43 (group I) were younger than 60 years (mean +/- SEM: 51.9 +/- 0.9 years, range: 37-59) and 18 patients (group II) were 60 years or older (64.1 +/- 0.7, range: 60-71). Main pre-transplant variables (sex, etiology of liver disease, presence of hepatocarcinoma, Child-Pugh's score and renal function) were similar in both groups. The follow-up (median and range) for group I was 28 and 3-47 months, and for group II 16.5 and 3-48 months. Actuarial survival rates at one and four years post-LT were respectively 88.3% and 85.6% for group I, and 87.8% and 87.8% for the group II (p = n.s.). There were no differences between both groups regarding the incidence of rejection, major infections, neurologic complications, renal failure, pathological bone fractures, diabetes mellitus or hypertension. Nevertheless, cardiovascular complications were significantly more frequent in group II (p = 0.002) although they were not the cause of death. In conclusion, our results show that the outcome of LT in patients over sixty years old is comparable to that observed in patients under that age. LT should not be contraindicated on the only basis of an age greater than 60 years.

Adult↗
PubMed1997

Patterns of failure and long-term results in high-risk resected gastric cancer treated with postoperative radiotherapy with or without intraoperative electron boost.

BACKGROUND: To evaluate the possible role of adjuvant radiotherapy in the management of high-risk resected gastric carcinoma. METHODS: From 1982 to 1993, 62 patients surgically resected of a primary gastric cancer with adverse pathological features (serosal and/or regional lymph node involvement) were treated with postoperative radiotherapy with (Group I) or without (Group II) intraoperative electron boost to the surgical bed and coeliac axis (IORT). RESULTS: After a median follow-up of 75.6 months (range 4-120+) for IORT patients and 91.2 months (range 6-149+) for non-IORT patients, overall relapse rates for Group I and Group II patients were 44.5% and 48.6% and local-regional relapse rates were 11.1% and 20%, respectively. Actuarial survival rates projected at the maximum follow-up were 41% and 38% in Groups I and II, respectively. CONCLUSIONS: This retrospective analysis suggests a beneficial effect of adjuvant external radiotherapy in promoting local-regional control in high-risk resected gastric cancer.

Adult↗
PubMed1993

Intraoperative radiotherapy in locally advanced recurrent colorectal cancer.

PURPOSE: In an effort to promote local control and improve quality of life in patients with recurrent colorectal cancer, a multimodality approach has been used. METHODS AND MATERIALS: Twenty-seven patients were treated with moderate doses of pre/postoperative radiotherapy with/without simultaneous systemic chemotherapy, surgical re-resection and IORT electron boost over areas at high risk for local recurrence. RESULTS: The 2-year actuarial disease-free and local relapse-free survival for the entire group were 14% and 26%, respectively. The most important factor predicting a favorable outcome was the radicality of surgical procedure. The determinate local control rate and the actuarial 2-year local relapse-free, and disease-free survival for patients undergoing complete resections were 50%, 56%, and 34%, respectively, whereas for patients undergoing partial resections these figures were 16%, 13%, and 6%. The radicality of surgical procedure was influenced by both tumoral size and previous treatment with irradiation. Complete resection rate was higher in patients with tumors less than 5 cm vs. more than 5 cm (40% vs. 22%), and in patients without previous radiotherapy versus those with previous radiotherapy (40% vs. 28%). Distant metastasis rate was high (41%). The most significant toxicities attributable to the whole treatment protocol were enteritis (37%), hydronephrosis (30%), and pelvic neuropathy (52%). CONCLUSION: Currently, our policy is to recommend IORT in patients with "favorable factors" such as: absence of previous pelvic radiotherapy, single previous surgical procedure, and complete resections.

Adult↗
PubMed1992

Intraoperative and external radiotherapy in resected gastric cancer: updated report of a phase II trial.

From September 1984 to August 1991, 48 evaluable patients with resected gastric cancer and apparent disease confined to locoregional area were treated with intraoperative electron beam boost to the celiac axis and peripancreatic nodal areas (15 Gy) and external irradiation (40 to 46 Gy in 4 to 5 weeks) including the gastric bed and upper abdominal nodal draining regions. At the time of evaluation for IORT, the disease was primary in 38 cases, recurrent but resectable in four (anastomosis), and unresectable in four (nodal). Post operative complications were reversible. Acute tolerance to the complete treatment program was acceptable. Late complications included life-threatening events: Six episodes of gastro intestinal bleeding (three of them had an arteriographic documentation of arterioenteric fistula) and nine with severe enteritis (five required reoperation). Other long-term treatment related complications were six cases of vertebral collapse. The median follow-up time for the entire group is 22 months. Locoregional recurrence/persistence of disease has been identified in five patients (three with residual and/or recurrent postsurgical tumor). Systemic tumor progression has been detected in 15 patients (11 in intra-abdominal sites). Overall actuarial survival for patients with positive or negative serosal involvement was 33% versus 56%. It is concluded that the treatment program described is able to induce a high locoregional tumor control rate (100%) when used strictly in an adjuvant setting and might control long term, a small portion of patients not amenable for curative surgery (2 out of 8 patients with confirmed residual post-surgical disease). Gastrointestinal bleeding and enteritis are findings that indicate treatment intensity at the upper limits of tissue tolerance. Assessment of long term tolerance of pancreatic parenchyma and large blood vessels (tissues included in the IRORT field) are pending for longer follow-up and the appropriate selective studies.

Humans↗
PubMed1991

[The role of leukotrienes and other eicosanoids in the response to an allograft. New perspectives on the control of rejection].

The role of eicosanoids in the development of immune response may be important to the viability of the implanted organ, given their complicated interaction with lymphokines and monokines which regulate the response. Due to this reason, more experiments in vivo are necessary to provide a better understanding of the behaviour of these compounds. This would help to clearly determine the role of these substances in the immune response--more exactly, in the allogenic transplant rejection--creating new ways for its control.

Antigen-Antibody Reactions↗
PubMed1982

Effect of colistin on reduction of biliary flow induced by endotoxin in E. coli.

In order to evaluate whether an antiendotoxin agent can inhibit the action of endotoxin of Escherichia coli on biliary flow, we used 18 models of isolated perfused pig liver divided into four groups: (A) five perfused livers (control), (B) five perfused livers with 2 mg/100 ml of endotoxin added, (C) five perfused livers with 2 mg/100 ml of endotoxin added and treated with 1,500,000 IU of colistin, and (D) three perfused livers with 1,500,000 IU of colistin with no endotoxin. The livers were isolated and perfused according to a technique previously described by our laboratory. The viability of the perfusions was controlled by means of the mitochondrial respiration test. Transaminase and LDH levels were measured in the perfused circuit. A significant reduction of the biliary flow was found in the group with endotoxin of Escherichia coli (P less than 0.002). There was no reduction of biliary flow after addition of 1,500,000 IU of colistin (P less than 0.001). No significant changes were observed in the other parameters measured, and no increase of the bile flow was observed in the colistin group. From our results we conclude that colistin is an inhibitor in vitro of the diminished biliary flow induced by endotoxin of Escherichia coli.

Alkaline Phosphatase↗
PubMedDate not supplied

Transjugular intrahepatic portocaval shunt after thrombus disruption in partially thrombosed portal veins.

Portal vein (PV) thrombosis increases the risk of variceal bleeding in cirrhotic patients with portal hypertension. Its presence also complicates PV access during transjugular porto-caval shunt (TIPS) placement. We overcame this obstacle by using ultrasound (US) guidance for PV entry. Clot disruption by balloon catheters was then performed before placing the vascular endoprostheses for portal-venous shunting. We treated 3 cirrhotic patients in such fashion with good clinical results. Portal thrombi progressively disappeared after shunting due to both balloon disruption and the rise in portal blood flow velocity.

Catheterization↗
PubMedDate not supplied

[Oxyphillic adenoma as a cause of primary hyperparathyroidism].

We describe three cases of women who developed symptoms of primary hyperparathyroidism originated by a parathyroid functional tumor. Ostoporosis, arterial hypertension and nefrolitiasis were the most frequent antecedents. The PTH and calcium levels in bood and urine were elevated. The CT and ultrasound confirmed the diagnosis of parathyroid tumor, which was identified histopathology as oxifilic adenoma. All patients underwent surgical treatment. We consider these cases of clinical interest because this kind of adenoma hardly ever produces hyperparathyroidism.

Adenoma↗