The use of endoprostheses in biliary fistula of hydatid cyst.
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Adult↗
Biomedical subjects
X de Aretxabala
Publications and source records attributed to X de Aretxabala.
Preoperative chemoradiotherapy in the treatment of gallbladder cancer.
Gallbladder cancer is generally associated with a poor prognosis, with local recurrence being the main pattern of failure. In an attempt to improve on the present status of management, we evaluated a prospective Phase II study involving preoperative 5-fluorouracil and radiation. Among 27 eligible patients with a potentially resectable gallbladder cancer detected after cholecystectomy, 18 were treated with preoperative radiation (4500 cGy; 180 cGy/fraction, 5 days/week) concurrent with a continuous infusion of 5-fluorouracil (350 mg/m2/day, days 1-5 and 21-25). Toxicity included leukopenia (8 patients) and thrombocytopenia (7 patients). Delay in surgery due to hematological toxicity was seen in 6 patients. Of the 18 patients, 15 underwent a reoperation. Resection was performed in 13 (86%). Pathologic findings after reoperation revealed residual tumor in both liver and lymph nodes in 3 patients. At a median follow-up of 24 months, 7 patients are alive. Among the patients who died after curative resection, local recurrence was demonstrated in only 1. This is the first report concerning preoperative chemoradiation in gallbladder cancer. To assess its effect on survival, a prospective randomized trial will be necessary.
Adult↗
Choledochoduodenostomy for common bile duct stones.
Among the techniques for dealing with common bile stones, choledochoduodenostomy (CDS) represents a useful alternative. This operation is indicated mainly in patients with recurrent stones, giant stones, or concomitant common bile stricture and duct stones. At the present time most of the patients undergoing CDS have been already undergone endoscopic retrograde cholangiography or ultrasonography to study the common bile duct and the cause of symptoms. The common bile duct diameter is of paramount importance when determining the feasibility of performing a CDS, the critical size being 1.2 cm. The most common operation is a side-to-side anastomosis employing absorbable sutures. Stomal patency is the most important factor for preventing classic complications such as cholangitis and sump syndrome. These complications are rare, being observed in only 5% of the patients. Long-term results of the operation show that it is a safe procedure that should be considered a good option in selected patients with choledocholithiasis.
Cholangitis↗
[Advances in the diagnosis and treatment of pancreatic carcinoma].
Pancreatic carcinoma has a dismal prognosis. In the last years, great efforts have been made to improve diagnosis and preoperative staging of potentially curable carcinomas. Actually, the diagnosis of fairly small tumours is possible. Chemoradiation therapy protocols prior to pancreatectomy, aiming to improve survival, are currently being held. This therapy allows radiation to be distributed into well oxygenated cells before surgical devascularization. This procedure can be done with acceptable morbidity and mortality rates. In selected cases of irresectable carcinoma, surgical palliation allows a better quality of life. Pancreatoduodenal resection, along with other traditional oncological therapies, will continue to be the therapy of choice for patients with carcinoma of the head of the pancreas, without local or regional metastases. However, an intensive search for new therapeutic strategies, specially in the field of molecular biology, is being carried out.
Carcinoma↗
[Tumor invasion in gallbladder cancer. Importance of blood vascular tumor infiltration diagnosis].
BACKGROUND: The infiltration of venous blood vessels in gallbladder carcinoma and its importance as a prognostic factor has not been well studied. Victoria blue stain has been used to identify vascular involvement in gastric and thyroidal carcinomas. AIM: To assess blood vessel infiltration using Victoria blue stain in gallbladder carcinomas. MATERIAL AND METHODS: One hundred forty eight samples of gallbladder carcinomas, coming from 24 men and 123 women aged 60.4 +/- 12.2 years old, were studied. They were stained with Victoria blue stain to quantify blood vessel invasion. RESULTS: Twenty nine percent of tumors had blood vessel infiltration, 61% had lymph vessel and 20% had perineural infiltration. Lymph vessel or perineural involvement was found in 81% and 31% of those tumors with blood vessel infiltration, respectively. Perineural infiltration was associated with lymph or vascular involvement in 93 and 40% of tumors, respectively. None of the early carcinomas had blood vessel infiltration, whereas 33% of advanced tumors had this type of infiltration (p < 0.001). No differences in vascular infiltration were observed according to the differentiation of the tumor. CONCLUSIONS: Blood vessel infiltration was observed only in advanced gallbladder carcinomas and was tightly related to the degree of gallbladder wall infiltration. The presence of perineural infiltration was the best marker of lymph or blood vessel infiltration.
Adenocarcinoma↗
p53 tumour suppressor gene protein expression in early and advanced gallbladder carcinoma.
AIMS: Gallbladder carcinoma is one of the most frequent malignant tumours occurring in Chile and the mortality rate in both sexes ranks among one of the highest in the world. Mutation of p53 tumour suppressor gene has been demonstrated in many tumours. Our aim was to determine protein expression of p53 gene in early and advanced gallbladder carcinoma. METHODS AND RESULTS: Protein expression of gene p53 was studied by immunohistochemical means in 191 gallbladder carcinomas (157 primary tumours, 34 metastases) and 25 controls. In 86 out of 191 cases (45%), protein expression of gene p53 was observed. Differences related to sex, age, or race were not observed. All gallbladder controls were negative. Twenty-five per cent of well-differentiated tumours were p53 positive, while moderate or poorly differentiated carcinomas reached 50% (P = 0.04). p53 expression was observed in 23.5% of early carcinomas and in 48.2% of advanced carcinomas (P = 0.01). No differences between primary tumours and metastasis were demonstrated. CONCLUSIONS: Protein expression of p53 tumour suppressor gene is observed in 45% of gallbladder carcinomas. The absence of expression in controls and in normal mucosa adjacent to tumours suggests its utility in differentiating atypical gallbladder epithelia from neoplastic lesions.
Carcinoma↗
DNA ploidy pattern and tumor suppressor gene p53 expression in gallbladder carcinoma.
The relationship between p53 gene expression and DNA content in advanced gallbladder carcinoma was studied. Fifty-three cases of advanced gallbladder carcinoma (45 primary tumors and 8 metastases) were analyzed, p53 protein expression was determined by immunohistochemistry, DNA content was measured by cytophotometric techniques. Study subjects included 45 (85%) female and 8 male patients, with an overall mean age of 58.6 years. Positive staining for p53 protein was observed in 27 (51%) cases. In subserosal tumors, the expression was significantly less than that in tumors that reached the serosa (P = 0.01). Twenty-nine (55%) cases were diploid and 24 were aneuploid. Sixty-seven % of primary tumors were diploid, whereas 87% of metastases showed an aneuploid DNA content. Both diploid and aneuploid tumors were positive for the p53 protein in the same proportion, and p53 was also expressed equally in both primary and secondary tumors. In advanced gallbladder carcinoma, the expression of the p53 gene was earlier than the accumulation of abnormal quantities of chromosomal DNA in the tumor cells. The determination of these events as markers in preneoplastic lesions is warranted in gallbladder carcinogenesis.
Adenocarcinoma↗
[CAA 19-9 and carcinoembryonic antigen in gallbladder cancer].
The aim of this work was to assess the diagnostic yield of serum tumoral markers, Ca 19-9 and carcinoembryonic antigen, in patients with gallbladder cancer. We studied 54 patients of whom 33 had gallbladder cancer and in 21 the tumor was removed previously and were presently free of disease. Twenty one patients with cholelithiasis were used as controls. Ca 19-9 was over 37 U/ml in 22 (65%) patients with cancer, in two patients free of disease and in two controls. The sensitivity and specificity of Ca 19-9 was 0.66 and 0.90 respectively. Carcinoembryonic antigen was over 2.5 ng/ml in 25 patients with cancer (56%) and its sensitivity and specificity was 0.75 and 0.71 respectively. Using a cutoff point of 4 ng/ml, these figures were 0.51 and 0.9 respectively. The better predictive capacity was given by a Ca 19-9 over 37 U/ml or a carcinoembryonic antigen over 4 ng/ml. It is concluded that, although the sensitivity and specificity of these markers was adequate in this work, one must bear in mind that studied patients had advanced tumors.
Adult↗
[Gallbladder cancer: a review].
In Chile, gallbladder cancer is the tumor with the highest mortality rates among women. Cholelithiasis is the most common associated factor and the reduction in cholecystectomy rates could be an important factor in the incidence of gallbladder cancer. Unfortunately, the disease is diagnosed late and the study of the surgical piece is the main form of early recognition. The degree of gallbladder wall infiltration by the tumor is the simplest and best staging method that has prognostic value. Gallbladder fat must be considered as a separate tissue, since its biological behavior differs from that of the subserous. The treatment of these tumors is based in their dissemination modality that is mainly local and regional. Surgical resection and radiotherapy are potentially effective. However the detection of high risk patients that should be subjected to cholecystectomy should be the better therapeutic alternative.
Female↗
[Pancreas divisium as a cause of chronic pancreatitis. Clinical case].
We report a 6 years old girl with chronic pancreatitis, presenting as recurring bouts of abdominal pain and hyperamylasemia, secondary to a lack of communication between the main papilla and pancreatic duct (pancreas divisium). The diagnosis was made during an intraoperative pancreatography and treatment consisted in a sphincteroplasty of the secondary papilla.
Child↗
Laparoscopic cholecystectomy and gallbladder cancer.
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Cholecystectomy, Laparoscopic↗
[Hereditary chronic pancreatitis. Report of a case].
Childhood hereditary pancreatitis is a rare entity of uncertain etiology, characterized by recurrent episodes of acute pancreatitis, abdominal pain and other unspecific symptoms. Among several therapeutic alternatives, pancreatojejunostomy is presently the treatment of choice. We report a 17 years old male with chronic hereditary pancreatitis that was treated with pancreatojejunostomy drainage.
Adolescent↗
[Laparoscopic cholecystectomy and gallbladder carcinoma].
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Adult↗
[Gallbladder cancer. Case-control study].
Gallbladder cancer is the principal oncological cause of death in chilean women and cholelithiasis is a well recognized risk factor. Aiming to unravel other risk factors for gallbladder cancer, we compared 50 patients subjected to cholecystectomy in whom a gallbladder cancer was found with 50 age and sex matched operated controls without cancer. Subjects were clinically assessed and interrogated about demographic, obstetrical features and feeding features. Multiples and early pregnancies were factors significantly associated to the development of gallbladder cancer. Twenty subjects (44%) with cancer knew that they had cholelithiasis and 41 patients in each group were symptomatic. It is concluded that pregnancy may be a risk factor for gallbladder cancer probably due to the lithogenic effect of its hormonal changes. Also, early cholecystectomy in symptomatic individuals may be an effective preventive measure.
Adult↗
[Laparoscopic cholecystectomy makes difficult the analysis of gallbladder mucosa. Morphometric study].
Laparoscopic gallbladder surgery damages gallbladder mucosa, impeding an adequate histological examination. We studied gallbladder samples coming from 56 conventional and 44 laparoscopic cholecystectomies performed in patients with chronic cholecystitis without signs of acute inflammation. The length of each examined sample and the length of the portion where superficial epithelia was not found was measured. No differences in sample length was found between both types of cholecystectomy. However; the segment with superficial mucosa was significantly shorter in the samples coming from laparoscopic surgery. Seventeen samples did not contain mucosa at all and 14 of these (82%) came from laparoscopic procedures. Eighty six percent of samples coming from laparoscopic surgery were considered inadequate for histological study compared to 36% of samples coming from conventional cholecystectomy. It is concluded that laparoscopic cholecystectomy hampers the study of gallbladder mucosa and may have an impact on the diagnosis of neoplastic gallbladder lesions.
Cholecystectomy↗
[Gallbladder cancer in the IX Region of Chile. Impact of the anatomopathological study of 474 cases].
We studied prospectively 474 cases (83% female with a female:male ratio of 5:1) of gallbladder carcinoma diagnosed in a period of 7 years. Twenty two percent of patients were younger than 50 years old. Ninety percent of tumors were adenocarcinomas. In 1987, 45% of cases were diagnosed in metastases compared to 1993, when only 10% of tumors were diagnosed in such histological material. Thirty four percent of tumors were not macroscopically identified; all these inapparent tumors were advanced in 1987, whereas 53% were incipient in 1993. Moreover, inapparent tumors had a significantly lower degree of gallbladder wall infiltration and higher degree of differentiation. Well differentiated tumors had a lesser degree of wall infiltration. It is concluded that the careful histopathological study of gallbladder cancer has allowed a thorough knowledge of the natural history and clinical presentation of gallbladder carcinoma.
Adenocarcinoma↗
[Gallbladder carcinoma: expression of the c-myc and ras-p-21 oncogene products].
The expression of c-myc and p-ras-21 oncogenes was studied using an immunohistochemical method with monoclonal antibodies in 126 samples of gallbladder carcinoma (103 primary tumors and 23 metastatic lesions). Twenty five gallbladder samples without tumor evidence were used as controls. C-myc oncoprotein was positive in one control sample and p-ras-21 oncoprotein was negative in all. Among primary carcinomas c-myc was positive in 9 (9%) and p-ras-21 in 4 (4%); among metastatic carcinomas c-myc was positive in 6 (26%, p = 0.03 vs primary carcinoma) and p-ras-21 in 11 (48%, p < 0.001 vs primary carcinoma). There was a non significant association between c-myc and p-ras-21 expression and degree of histological differentiation and level of tumoral infiltration. It is concluded that c-myc and p-ras-21 oncoprotein expression is observed in less than 10% of primary gallbladder carcinomas and that this expression is significantly higher in metastatic carcinomas. This may reflect an activation or overexpression of these oncogenes in metastatic cells.
Amino Acid Sequence↗
[Determination of DNA content using cytophotometry in nuclear suspension conserved for prolonged periods (preliminary study)].
The variations in cytophotometric determination of DNA content were studied in a concentrated suspension of nuclei stored for prolonged periods. These came from normal and tumoral cells of an uterine leiomyosarcoma, fixed in formalin and included in paraffin. DNA was measured in normal and tumoral cells at days 0, 1, 7, 11, 19, 27 and 33. No significant variations in DNA measurement were observed. In a same day, there was an uniform DNA content, ploidy pattern and DNA index and an aneuploid pattern was diagnosed in all histograms. These results suggest that nuclear suspensions can be conserved for long periods and used for DNA content determination, allowing the access of remote places to these techniques.
Cytophotometry↗