Miguel Angel Mercado-Díaz

PubMedDate not supplied

[Portal biliopathy].

Portal biliopathy is a rare condition that is usually not diagnosed. It is associated with presence of varix around bile duct with concomitant ischemic damage and structural alterations of bile duct wall; this produces obstructive phenomena. There are scarce reports on the literature this entity. In the present paper, we report two cases in which obstruction of extrahepatic bile duct was associated with cholecystitis with well-documented extrahepatic portal hypertension. Both cases were managed with cholecystectomy and endoscopic placement of endoprothesis. Treatment of portal biliopathy should be adjusted to the individual patient's characteristics. It is focused on the one hand on management of portal hypertension and on the other hand to management of obstructive jaundice. When cholecistitis is found, cholecistectomy should to be performed. If the patient develops concomitant gastrointestinal bleeding due to portal hypertension, management of the problem could require surgical devascularization, shunting procedures, or endoscopic variceal ligature.

Adult↗

PubMedDate not supplied

[Prognostic factor in gallbladder cancer].

BACKGROUND: Gallbladder cancer is a rare and aggressive neoplasm. OBJECTIVE: The purpose of this manuscript was to evaluate the prognostic factors associated with overall survival in gallbladder cancer patients. METHODS: We performed a retrospective study of the patients with gallbladder cancer who received attention in a tertiary referral center in Mexico City during a 13 year period (1990-2002). We evaluated demographic, clinical, pathological and treatment variables. The main outcome variable was overall survival. The survival curves were constructed with the Kaplan and Meier method and compared with the log-rank test. Multivariate analyses was performed with the Cox regression method. We considered significant p < 0.05. RESULTS: Fifty-one patients were registered, 35 of them women (69%). Median patient age was 63 years. Fifty-seven percent of patients had previous diagnosis of cholelithiasis. Seventy-one percent of patients underwent surgery. Ninety-eight percent of the tumors were adenocarcinoma and 25% were poorly differentiated. Eighty-six percent were found to have stage IV. Median survival for the entire cohort was six months (95% CI 0.5-7), and actuarial survival at one and three years was 22.7% and 3.9% respectively. On univariate analysis surgery, early stage, chemotherapy, Karnofsky 2 80 and serum albumin > 3.0 g/dL were associated with better prognosis. On multivariate analysis, only surgery (p = 0.0001) and serum albumin > 3 g/dL (p = 0.002) remained significantly associated with better outcome. CONCLUSIONS: Most cases of gallbladder cancer presented with advanced stage. Serum albumin is a prognostic factor for survival in this group of patients.

Female↗