ESTELA REGINA RAMOS FIGUEIRA - Academia.edu (original) (raw)

Papers by ESTELA REGINA RAMOS FIGUEIRA

Research paper thumbnail of Mixed bile duct ligature increases animal survival with increased liver fibrosis

Research paper thumbnail of Estado atual das ressecções pancreáticas por via robótica

ABCD Express, Nov 11, 2017

Research paper thumbnail of Hepatectomias segmentares no fígado cirrótico: resultadosdo acesso intra-hepático aos pedículos glissonianos

Revista do Colégio Brasileiro de Cirurgiões, 2005

Research paper thumbnail of Risk factors for severe complications in elderly patients submitted to pancreatoduodenectomy for periampullary tumors

Research paper thumbnail of Laparoscopic resection of solid pseudopapillary neoplasm of the pancreas

Hpb, Apr 1, 2016

key. In vitro inhibition of HK with 2-deoxy-glucose, PFK with aurintricarboxylic acid, GPD with i... more key. In vitro inhibition of HK with 2-deoxy-glucose, PFK with aurintricarboxylic acid, GPD with iodoacetate and PGI with insulinlike growth factor protein (IGFR-protein) causes inhibition of PDAC growth. Conclusion: In vitro studies demonstrate that targetting of pathways specifically upregulated in PDAC may provide a logical and novel route to causing cancer cell death in this disease.

Research paper thumbnail of Duodenopancreatectomia minimamente invasiva para tratamento de adenocarcinoma de papila duodenal

ABCD Express, Nov 11, 2017

Research paper thumbnail of Analysis of preliminary experience with robotic approach to distal pancreatectomy

Research paper thumbnail of Outcomes of laparoscopic cholecystectomy for acute and chronic cholecystitis in elderly patients: Preliminary results

Hpb, Apr 1, 2016

Results: LCBDE was performed via a transcystic approach in 7 and via choledochotomy in 13 patient... more Results: LCBDE was performed via a transcystic approach in 7 and via choledochotomy in 13 patients. Median (range) operating time was 120 (90e210) minutes. Simultaneous cholecystectomy was performed in 16 patients. LCBDE was performed after Roux-en-Y gastric bypass surgery in 5 patients. One patient was converted to an open common bile duct exploration because of stone impaction. Stone clearance was succesful in all patients. Postoperative complications were a subcapsular liver hematoma (Clavien-Dindo type 2), a bile leak (Clavien-Dindo type 3b) and a superficial surgical site infections (Clavien-Dindo type 1) in three different patients. Median (range) length of hospital stay was 3 (1e10) days. Conclusions: LCBDE is feasible at a non-academic teaching hospital with high stone clearance and low complication rates.

Research paper thumbnail of Structured imaging report of hilar cholangiocarcinoma: how to highlight the critical findings

Hpb, Apr 1, 2017

Results: A total of 40 observational studies (1416 patients) met the inclusion criteria (n = 5 ca... more Results: A total of 40 observational studies (1416 patients) met the inclusion criteria (n = 5 case controlled studies, n = 35 case series). Median 5-year survival across the studies was 38% (range 18%e78%). Median disease free interval between studies was 55 (range 35e75) months. Pooled analysis identified the following variables associated with a greater overall survival: R0 resection compared to R1/2 (n = 6, OR = 4.07, p < 0.0001), positive hormone receptor status (n = 4, OR = 3.01, p = 0.0026), single hepatic metastasis (n = 4, OR = 2.20, p = 0.0221) and having metastases confined to the liver (n = 3, OR = 5.08, p = 0.0008). Review of prognostic factors identified three studies where a disease free interval greater than 12 months (HR = 5.15, p = 0.0097), 24 months (HR = 2.9, p < 0.05) and 36 months (HR = 8.69, p = 0.003) is associated with worse overall survival. One study identified that disease progression following neoadjuvant chemotherapy reduces overall survival (HR 3.8, p = 0.003). Conclusion: Liver surgery for breast cancer liver metastases may improve outcomes in selected patients (positive hormone receptor, single metastasis confined to liver with long disease free interval) based on low level evidence available in literature. Prospective randomized controlled trials are necessary to determine the true clinical efficacy.

Research paper thumbnail of First description of extended and tailored fluorescence guided lymphadenectomy during robotic distal pancreatosplenectomy: case report

Journal of visualized surgery, Jul 1, 2023

Background: Minimally invasive distal pancreatosplenectomies for the treatment of pancreatic duct... more Background: Minimally invasive distal pancreatosplenectomies for the treatment of pancreatic duct adenocarcinoma (PDAC) of the pancreatic body have become a well-established approach. To improve oncologic resection and lymph node (LN) dissection, technical alternatives have emerged on the last few years, such as the radical antegrade modular pancreatosplenectomy (RAMPS). While it is accepted that 12 LNs should be retrieved during distal pancreatosplenectomies, during RAMPS procedure the mean harvest is described to be 21 LNs (range, 11-30). With the objective of performing extended and tailored lymphadenectomies during robotic distal pancreatosplenectomies, we developed a novel technique for LN dissection with the use of real-time near-infrared robotic fluorescence and direct injection of indocyanine green in the pancreas as a contrast agent. Case Description: The patient presented pathologically confirmed PDAC on the body of the pancreas and was submitted to totally robotic distal pancreatosplenectomy. After exposing the pancreatic body and under intraoperative sonography guidance, 1 mL of indocyanine green was injected on the pancreas just proximal to the tumor. Using robotic fluorescence, we could clearly identify the lymphatic drainage of the pancreatic body, in order to perform fluorescence-guided, extended and tailored lymphadenectomy. Operative time was 4 hours and 43 minutes. Forty-three LNs were retrieved. Surgical margin was free from neoplasia. Postoperative period was uneventful. Conclusions: Fluorescence-guided extended lymphadenectomy with intrapancreatic injection of indocyanine green is a novel technique that may improve oncological results and staging during robotic distal pancreatosplenectomies for the treatment of PDAC of the pancreatic body.

Research paper thumbnail of Insights of Outcome after Resection of Small Nonfunctioning Neuroendocrine Pancreatic Tumors

Gastroenterology Research and Practice, Apr 24, 2021

Background. The incidence of small nonfunctioning neuroendocrine pancreatic tumors (NF-PNETs) has... more Background. The incidence of small nonfunctioning neuroendocrine pancreatic tumors (NF-PNETs) has been increasing systematically in the last few decades. Surgical resection was once considered the treatment of choice but has been questioned in the direction of a more conservative approach for selected patients. Our aim was to analyze the outcome of surgical resection of small (≤3cm) NF-PNETs. Methods. We retrospectively evaluated 14 patients with sporadic NF-PNETs who underwent pancreatic resection. Data were collected from patients' medical records. Results. Of the 14 patients included, 35.71% were men, and the average age was 52:36 ± 20:36 years. Comorbidities were present in 92.86% of the cases. The incidence of postoperative complications was 42.86%, the 30-day mortality was zero, and the length of follow-up was 3:31 ± 3:0 years. The results of pathological evaluations revealed WHO grade I in 42.86% of cases, II in 21.43%, and neuroendocrine carcinoma in 35.71%. The median tumor size was 1.85cm (range, 0.5-3cm), and 2 cases had synchronous metastasis. The median TNM stage was IIa (range, I-IV). The disease-free and patient survival rates were 87.5% and 100% at 3 years and 43.75% and 75% at 10 years, respectively. The tumor pathological grade was significantly higher in head tumors than body-tail tumors, but there were no differences with respect to tumor size and TNM staging. Conclusion. A surgical approach to treat small sporadic NF-PNETs is safe with low mortality and high patient survival. Based on these data, small pancreatic head tumors can be more aggressive, suggesting that surgical resection is still the best option to treat small nonfunctioning PNETS. Thus, conservative treatment should be indicated very cautiously for only cases with absolute contraindications for surgery.

Research paper thumbnail of Technical aspects of surgical repair of complex iatrogenic biliary strictures

Research paper thumbnail of Preconditioning by sevoflurane metabolite hexafluoro-2-propanol decreases liver ischemia reperfusion injury: preliminary results

Hpb, Sep 1, 2018

Tranjugular intrahepatic portosystemic shunt (TIPS) has became increasingly relevant in controlli... more Tranjugular intrahepatic portosystemic shunt (TIPS) has became increasingly relevant in controlling recurrent variceal bleeding and intractable ascites in patients with portal hypertension due to advanced liver cirrhosis. Complications and success rate seem to be related to the pre-procedure conditions of the patients. The endopoints of this study are to value outcome of patients with variceal bleeding and ascites. Methods: Between 2013 and 2017, 41 patients with mean age 58.6 AE 10.9 years, underwent TIPS. Indications were variceal bleeding in 20 patients, ascites in 19 patients, both in 1 and post-LT (liver transplantation) in 1 patient; in 3 patients the procedures were subsequent to LT and in other 10 patients were carried out as bridge to LT. Clinical status was assessed according to the model of end-stage liver disease (MELD), pre and post-TIPS gradient pressure were measured, as well as ammonemia level. Outcome was valued assessing recurrence of bleeding or ascites and survival. Results: Pre and post-TIPS comparison showed a statistically significant reduction in portal pressure gradient (18.4 vs 10.5 mmHg) with an increase in ammonemia level (49.4 vs 59.5 mmol/L) without clinical syptoms; however no differences were observed in MELD (13.8 vs 14.3). Bleeding and ascites recurred in 4 out of 21 patients and in 14 out of 20 patients, respectively. Encephalopathy was present in 11 patients. Overall actuarial survival was 82%, 74% and 47% at 6, 12 and 24 months, respectively. Conclusion: TIPS seems to reduce more efficacy the risk of bleeding than ascites without modifying liver function.

Research paper thumbnail of Resultados Tardios Do Tratamento Cirurgico Da Pancreatite Cronica

ABCD Express, Nov 11, 2017

Research paper thumbnail of Complicações cirúrgicas a curto prazo após a colecistectomia laparoscópica em pacientes com idade avançada

ABCD Express, Nov 11, 2017

Research paper thumbnail of Preliminary results of surgical repair of iatrogenic biliary strictures in a single center

Hpb, Apr 1, 2017

Objective: Hepatocellular carcinoma (HCC) has an overall 5-year survival of 17.5%, and will lead ... more Objective: Hepatocellular carcinoma (HCC) has an overall 5-year survival of 17.5%, and will lead to an estimated 27,170 deaths in the United States (US) in 2016. Previous evidence suggests that HCC outcomes are worse in Nevada (NV). This research investigated HCC inpatient outcomes, and examined putative HCC etiology and patient demographics for disparities. Methods: Adult inpatient hospitalizations from 2008 to 2012 in NV and the US were retrospectively reviewed using the Nationwide Inpatient Sample and NV State Inpatient Database of the Healthcare Cost and Utilization Project. We identified 60,220 US and 2107 NV hospitalizations with diagnosed HCC using ICD-9-CM codes. Metabolic syndrome (MetS), alcohol use, and viral hepatitis ICD-9-CM codes were used to create putative etiology subgroups (Viral-HCC, MetS-HCC, Alcohol-HCC), a multiple-cause subgroup (Multiple-HCC), and a cryptogenic subgroup (Other-HCC). Weighted logistic regression analyses were conducted using SAS/STAT Ò software version 9.4. Results: Overall-HCC, MetS-HCC, Alcohol-HCC, and Other-HCC accounted for significantly greater hospitalization charges in NV compared to the US (Table 1). Alcohol-HCC and Multiple-HCC had greater mean length of stay (LOS) in NV (Table 1). Other-HCC had lower inhospital mortality in NV (p = 0.045). The US mortality odds ratio was 1.31 for AfricaneAmerican (p < 0.001) and 1.58 for Native American (p = 0.021) compared to Caucasian patients, and 1.84 (p < 0.001) for self-pay compared to Medicare patients. Conclusion: Compared to the US, Nevadan HCC hospitalizations had increased LOS (Alcohol-HCC and Multiple-HCC) and increased total charges (MetS-HCC, Alcohol-HCC, Other-HCC, Overall-HCC). Confirming previous findings, disparities varied by ethnicity and insurance status, highlighting the need for further investigation and population health interventions.

Research paper thumbnail of Total laparoscopic central pancreatectomy

Hpb, Apr 1, 2016

Background: Pancreaticoduodenectomy (PD) is one of the most formidable surgeries. Even such compl... more Background: Pancreaticoduodenectomy (PD) is one of the most formidable surgeries. Even such complicated procedures have been occupied by the minimally invasive approach in far advanced laparoscopic era. We would like to introduce our early experience of totally laparoscopic PD. Materials and methods: The patients were prepared in supine position and five trocars were used. Following resection, all of the reconstructions were accomplished by the laparoscopic approach intracorporeally. The specimen was retrieved through a small extension of skin incision of the umbilical camera port. Result: From March 2014 to August 2015, nine patients underwent laparoscopic PD. Pathology of resected lesions included 3 ampulla of Vater cancer, 2 bile duct cancer, 2 pancreatic cancer, 1 duodenal cancer, and 1 mucinous cystic tumor. Number of nodes harvested was 11.6 AE 2.8. The mean total operative time was 486 AE 84 min, and the mean estimated blood loss was 622 AE 281 ml. One patient was converted to minilaparotomy because of difficult dissection of the uncinate process, which patient had grade B pancreatic leakage. There was no clinically significant complications except previous one patient. The mean length of stay after surgery was 12.8 AE 4.6 days. Conclusion: Despite of worrisome potential risk and complications, laparoscopic PD could be performed safely with competent short-term outcomes. However, it is still a technically demanding and hardship operation during the initial learning curve. Further studies to evaluate long-term favorable outcomes and to develop proper training program for a steep learning curve are required.

Research paper thumbnail of Insulinomas versus non-functioning neuroendocrine pancreatic tumors: Aspects of dignosis and outcome after pancreatic resection

Hpb, Apr 1, 2016

Despite advances in the surgical management and adjuvant chemotherapy, pancreatic cancer still ha... more Despite advances in the surgical management and adjuvant chemotherapy, pancreatic cancer still has a very poor prognosis. Nanotechnology provides a novel approach for targeted drug delivery, possibly reducing the offset effects of systemic chemotherapy. Superparamagnetic iron oxide nanoparticles (SPIONs) are inorganic particles that can be functionalised as targeted drug vehicles with a stealth polymer coating and a specific antibody tag to recognise appropriate antigen expressing cells. Our aim is to develop and investigate the effects of SPIONs capable of targeted cell death of pancreatic cells by release of its chemotherapy payload. Methods: Micellar SPIONs, incorporating a gemcitabine pro-drug, conjugated to isotype and anti-CA19.9 antibodies (NP:CA19.9) were manufactured using self assembly methodology. Cellular uptake was assessed using transmission electron and co-localisation fluorescent microscopy. Antigen expression of cell lines was determined using indirect immunofluorescence. Antibody targeting was assessed using EZ4U cytotoxicity assay in BxPC-3 (Ca-19-9 +ve) and MiaPaCa-2 (Ca-19-9-ve) cell lines. Results: Endocytosis of the SPIONs was demonstrated by their presence in endosomes and corroborated by colocalisation analysis (Manders coefficient = 0.92). The IC50 of gemcitabine was significantly improved using a nanohybrid attached with specific antibody targeting in BxPC-3 cells (10.245Î 1 / 4 M vs 5.143Î 1 / 4 M) [p < 0.001] but absent in MiaPaCa-2 cells (2.322Î 1 / 4 M vs 2.486Î 1 / 4 M) [n = 3]. Conclusions: We have developed a novel nanohybrid to target antigen expressing pancreatic cancer cells using a specific antibody tag. When loaded with modified gemcitabine, these SPIONs act as pH-triggered delivery vehicles capable of intracellular drug release. This could reduce off target effects leading to increased chemotherapy agent efficacy and offer the prospect for new treatments in pancreatic cancer.

Research paper thumbnail of Risk factors associated with pancreatic fistulas after pancreatoduodenectomy: development and internal validation of a preoperative nomogram

Background Most complications after pancreatoduodenectomy (PD) are due to pancreatic fistula (PF)... more Background Most complications after pancreatoduodenectomy (PD) are due to pancreatic fistula (PF). Therefore, predicting PF is important to individualize treatment. The aim of this study is to develop a preoperative nomogram to predict PF after PD. Methods From January 2009 to January 2018, patients that underwent PD were reviewed. After univariate analyses, variables with p < 0.1 were selected for a multivariate analysis. Variables with p < 0.05 were then included in the nomogram, which was internally validated in a different set of patients. Results Out of 180 patients evaluated, 19.4% experienced PF. Risk factors for PF were male gender (OR = 2.89), higher BMI (OR = 1.14) and pancreatic duct diameter ≤ 3 mm (OR = 3.52). Weight loss greater than 10% was protective against PF (OR = 0.16). Using these four variables, a preoperative nomogram was built. The nomogram performed well in the validation set (n = 82 patients, 25.6% with PF) with an area under the ROC curve of 0.798. C...

Research paper thumbnail of Hexafluoroisopropanol decreases liver ischemia–reperfusion injury by downregulation of high mobility group box‐1 protein

Pharmacology Research & Perspectives

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Research paper thumbnail of Mixed bile duct ligature increases animal survival with increased liver fibrosis

Research paper thumbnail of Estado atual das ressecções pancreáticas por via robótica

ABCD Express, Nov 11, 2017

Research paper thumbnail of Hepatectomias segmentares no fígado cirrótico: resultadosdo acesso intra-hepático aos pedículos glissonianos

Revista do Colégio Brasileiro de Cirurgiões, 2005

Research paper thumbnail of Risk factors for severe complications in elderly patients submitted to pancreatoduodenectomy for periampullary tumors

Research paper thumbnail of Laparoscopic resection of solid pseudopapillary neoplasm of the pancreas

Hpb, Apr 1, 2016

key. In vitro inhibition of HK with 2-deoxy-glucose, PFK with aurintricarboxylic acid, GPD with i... more key. In vitro inhibition of HK with 2-deoxy-glucose, PFK with aurintricarboxylic acid, GPD with iodoacetate and PGI with insulinlike growth factor protein (IGFR-protein) causes inhibition of PDAC growth. Conclusion: In vitro studies demonstrate that targetting of pathways specifically upregulated in PDAC may provide a logical and novel route to causing cancer cell death in this disease.

Research paper thumbnail of Duodenopancreatectomia minimamente invasiva para tratamento de adenocarcinoma de papila duodenal

ABCD Express, Nov 11, 2017

Research paper thumbnail of Analysis of preliminary experience with robotic approach to distal pancreatectomy

Research paper thumbnail of Outcomes of laparoscopic cholecystectomy for acute and chronic cholecystitis in elderly patients: Preliminary results

Hpb, Apr 1, 2016

Results: LCBDE was performed via a transcystic approach in 7 and via choledochotomy in 13 patient... more Results: LCBDE was performed via a transcystic approach in 7 and via choledochotomy in 13 patients. Median (range) operating time was 120 (90e210) minutes. Simultaneous cholecystectomy was performed in 16 patients. LCBDE was performed after Roux-en-Y gastric bypass surgery in 5 patients. One patient was converted to an open common bile duct exploration because of stone impaction. Stone clearance was succesful in all patients. Postoperative complications were a subcapsular liver hematoma (Clavien-Dindo type 2), a bile leak (Clavien-Dindo type 3b) and a superficial surgical site infections (Clavien-Dindo type 1) in three different patients. Median (range) length of hospital stay was 3 (1e10) days. Conclusions: LCBDE is feasible at a non-academic teaching hospital with high stone clearance and low complication rates.

Research paper thumbnail of Structured imaging report of hilar cholangiocarcinoma: how to highlight the critical findings

Hpb, Apr 1, 2017

Results: A total of 40 observational studies (1416 patients) met the inclusion criteria (n = 5 ca... more Results: A total of 40 observational studies (1416 patients) met the inclusion criteria (n = 5 case controlled studies, n = 35 case series). Median 5-year survival across the studies was 38% (range 18%e78%). Median disease free interval between studies was 55 (range 35e75) months. Pooled analysis identified the following variables associated with a greater overall survival: R0 resection compared to R1/2 (n = 6, OR = 4.07, p < 0.0001), positive hormone receptor status (n = 4, OR = 3.01, p = 0.0026), single hepatic metastasis (n = 4, OR = 2.20, p = 0.0221) and having metastases confined to the liver (n = 3, OR = 5.08, p = 0.0008). Review of prognostic factors identified three studies where a disease free interval greater than 12 months (HR = 5.15, p = 0.0097), 24 months (HR = 2.9, p < 0.05) and 36 months (HR = 8.69, p = 0.003) is associated with worse overall survival. One study identified that disease progression following neoadjuvant chemotherapy reduces overall survival (HR 3.8, p = 0.003). Conclusion: Liver surgery for breast cancer liver metastases may improve outcomes in selected patients (positive hormone receptor, single metastasis confined to liver with long disease free interval) based on low level evidence available in literature. Prospective randomized controlled trials are necessary to determine the true clinical efficacy.

Research paper thumbnail of First description of extended and tailored fluorescence guided lymphadenectomy during robotic distal pancreatosplenectomy: case report

Journal of visualized surgery, Jul 1, 2023

Background: Minimally invasive distal pancreatosplenectomies for the treatment of pancreatic duct... more Background: Minimally invasive distal pancreatosplenectomies for the treatment of pancreatic duct adenocarcinoma (PDAC) of the pancreatic body have become a well-established approach. To improve oncologic resection and lymph node (LN) dissection, technical alternatives have emerged on the last few years, such as the radical antegrade modular pancreatosplenectomy (RAMPS). While it is accepted that 12 LNs should be retrieved during distal pancreatosplenectomies, during RAMPS procedure the mean harvest is described to be 21 LNs (range, 11-30). With the objective of performing extended and tailored lymphadenectomies during robotic distal pancreatosplenectomies, we developed a novel technique for LN dissection with the use of real-time near-infrared robotic fluorescence and direct injection of indocyanine green in the pancreas as a contrast agent. Case Description: The patient presented pathologically confirmed PDAC on the body of the pancreas and was submitted to totally robotic distal pancreatosplenectomy. After exposing the pancreatic body and under intraoperative sonography guidance, 1 mL of indocyanine green was injected on the pancreas just proximal to the tumor. Using robotic fluorescence, we could clearly identify the lymphatic drainage of the pancreatic body, in order to perform fluorescence-guided, extended and tailored lymphadenectomy. Operative time was 4 hours and 43 minutes. Forty-three LNs were retrieved. Surgical margin was free from neoplasia. Postoperative period was uneventful. Conclusions: Fluorescence-guided extended lymphadenectomy with intrapancreatic injection of indocyanine green is a novel technique that may improve oncological results and staging during robotic distal pancreatosplenectomies for the treatment of PDAC of the pancreatic body.

Research paper thumbnail of Insights of Outcome after Resection of Small Nonfunctioning Neuroendocrine Pancreatic Tumors

Gastroenterology Research and Practice, Apr 24, 2021

Background. The incidence of small nonfunctioning neuroendocrine pancreatic tumors (NF-PNETs) has... more Background. The incidence of small nonfunctioning neuroendocrine pancreatic tumors (NF-PNETs) has been increasing systematically in the last few decades. Surgical resection was once considered the treatment of choice but has been questioned in the direction of a more conservative approach for selected patients. Our aim was to analyze the outcome of surgical resection of small (≤3cm) NF-PNETs. Methods. We retrospectively evaluated 14 patients with sporadic NF-PNETs who underwent pancreatic resection. Data were collected from patients' medical records. Results. Of the 14 patients included, 35.71% were men, and the average age was 52:36 ± 20:36 years. Comorbidities were present in 92.86% of the cases. The incidence of postoperative complications was 42.86%, the 30-day mortality was zero, and the length of follow-up was 3:31 ± 3:0 years. The results of pathological evaluations revealed WHO grade I in 42.86% of cases, II in 21.43%, and neuroendocrine carcinoma in 35.71%. The median tumor size was 1.85cm (range, 0.5-3cm), and 2 cases had synchronous metastasis. The median TNM stage was IIa (range, I-IV). The disease-free and patient survival rates were 87.5% and 100% at 3 years and 43.75% and 75% at 10 years, respectively. The tumor pathological grade was significantly higher in head tumors than body-tail tumors, but there were no differences with respect to tumor size and TNM staging. Conclusion. A surgical approach to treat small sporadic NF-PNETs is safe with low mortality and high patient survival. Based on these data, small pancreatic head tumors can be more aggressive, suggesting that surgical resection is still the best option to treat small nonfunctioning PNETS. Thus, conservative treatment should be indicated very cautiously for only cases with absolute contraindications for surgery.

Research paper thumbnail of Technical aspects of surgical repair of complex iatrogenic biliary strictures

Research paper thumbnail of Preconditioning by sevoflurane metabolite hexafluoro-2-propanol decreases liver ischemia reperfusion injury: preliminary results

Hpb, Sep 1, 2018

Tranjugular intrahepatic portosystemic shunt (TIPS) has became increasingly relevant in controlli... more Tranjugular intrahepatic portosystemic shunt (TIPS) has became increasingly relevant in controlling recurrent variceal bleeding and intractable ascites in patients with portal hypertension due to advanced liver cirrhosis. Complications and success rate seem to be related to the pre-procedure conditions of the patients. The endopoints of this study are to value outcome of patients with variceal bleeding and ascites. Methods: Between 2013 and 2017, 41 patients with mean age 58.6 AE 10.9 years, underwent TIPS. Indications were variceal bleeding in 20 patients, ascites in 19 patients, both in 1 and post-LT (liver transplantation) in 1 patient; in 3 patients the procedures were subsequent to LT and in other 10 patients were carried out as bridge to LT. Clinical status was assessed according to the model of end-stage liver disease (MELD), pre and post-TIPS gradient pressure were measured, as well as ammonemia level. Outcome was valued assessing recurrence of bleeding or ascites and survival. Results: Pre and post-TIPS comparison showed a statistically significant reduction in portal pressure gradient (18.4 vs 10.5 mmHg) with an increase in ammonemia level (49.4 vs 59.5 mmol/L) without clinical syptoms; however no differences were observed in MELD (13.8 vs 14.3). Bleeding and ascites recurred in 4 out of 21 patients and in 14 out of 20 patients, respectively. Encephalopathy was present in 11 patients. Overall actuarial survival was 82%, 74% and 47% at 6, 12 and 24 months, respectively. Conclusion: TIPS seems to reduce more efficacy the risk of bleeding than ascites without modifying liver function.

Research paper thumbnail of Resultados Tardios Do Tratamento Cirurgico Da Pancreatite Cronica

ABCD Express, Nov 11, 2017

Research paper thumbnail of Complicações cirúrgicas a curto prazo após a colecistectomia laparoscópica em pacientes com idade avançada

ABCD Express, Nov 11, 2017

Research paper thumbnail of Preliminary results of surgical repair of iatrogenic biliary strictures in a single center

Hpb, Apr 1, 2017

Objective: Hepatocellular carcinoma (HCC) has an overall 5-year survival of 17.5%, and will lead ... more Objective: Hepatocellular carcinoma (HCC) has an overall 5-year survival of 17.5%, and will lead to an estimated 27,170 deaths in the United States (US) in 2016. Previous evidence suggests that HCC outcomes are worse in Nevada (NV). This research investigated HCC inpatient outcomes, and examined putative HCC etiology and patient demographics for disparities. Methods: Adult inpatient hospitalizations from 2008 to 2012 in NV and the US were retrospectively reviewed using the Nationwide Inpatient Sample and NV State Inpatient Database of the Healthcare Cost and Utilization Project. We identified 60,220 US and 2107 NV hospitalizations with diagnosed HCC using ICD-9-CM codes. Metabolic syndrome (MetS), alcohol use, and viral hepatitis ICD-9-CM codes were used to create putative etiology subgroups (Viral-HCC, MetS-HCC, Alcohol-HCC), a multiple-cause subgroup (Multiple-HCC), and a cryptogenic subgroup (Other-HCC). Weighted logistic regression analyses were conducted using SAS/STAT Ò software version 9.4. Results: Overall-HCC, MetS-HCC, Alcohol-HCC, and Other-HCC accounted for significantly greater hospitalization charges in NV compared to the US (Table 1). Alcohol-HCC and Multiple-HCC had greater mean length of stay (LOS) in NV (Table 1). Other-HCC had lower inhospital mortality in NV (p = 0.045). The US mortality odds ratio was 1.31 for AfricaneAmerican (p < 0.001) and 1.58 for Native American (p = 0.021) compared to Caucasian patients, and 1.84 (p < 0.001) for self-pay compared to Medicare patients. Conclusion: Compared to the US, Nevadan HCC hospitalizations had increased LOS (Alcohol-HCC and Multiple-HCC) and increased total charges (MetS-HCC, Alcohol-HCC, Other-HCC, Overall-HCC). Confirming previous findings, disparities varied by ethnicity and insurance status, highlighting the need for further investigation and population health interventions.

Research paper thumbnail of Total laparoscopic central pancreatectomy

Hpb, Apr 1, 2016

Background: Pancreaticoduodenectomy (PD) is one of the most formidable surgeries. Even such compl... more Background: Pancreaticoduodenectomy (PD) is one of the most formidable surgeries. Even such complicated procedures have been occupied by the minimally invasive approach in far advanced laparoscopic era. We would like to introduce our early experience of totally laparoscopic PD. Materials and methods: The patients were prepared in supine position and five trocars were used. Following resection, all of the reconstructions were accomplished by the laparoscopic approach intracorporeally. The specimen was retrieved through a small extension of skin incision of the umbilical camera port. Result: From March 2014 to August 2015, nine patients underwent laparoscopic PD. Pathology of resected lesions included 3 ampulla of Vater cancer, 2 bile duct cancer, 2 pancreatic cancer, 1 duodenal cancer, and 1 mucinous cystic tumor. Number of nodes harvested was 11.6 AE 2.8. The mean total operative time was 486 AE 84 min, and the mean estimated blood loss was 622 AE 281 ml. One patient was converted to minilaparotomy because of difficult dissection of the uncinate process, which patient had grade B pancreatic leakage. There was no clinically significant complications except previous one patient. The mean length of stay after surgery was 12.8 AE 4.6 days. Conclusion: Despite of worrisome potential risk and complications, laparoscopic PD could be performed safely with competent short-term outcomes. However, it is still a technically demanding and hardship operation during the initial learning curve. Further studies to evaluate long-term favorable outcomes and to develop proper training program for a steep learning curve are required.

Research paper thumbnail of Insulinomas versus non-functioning neuroendocrine pancreatic tumors: Aspects of dignosis and outcome after pancreatic resection

Hpb, Apr 1, 2016

Despite advances in the surgical management and adjuvant chemotherapy, pancreatic cancer still ha... more Despite advances in the surgical management and adjuvant chemotherapy, pancreatic cancer still has a very poor prognosis. Nanotechnology provides a novel approach for targeted drug delivery, possibly reducing the offset effects of systemic chemotherapy. Superparamagnetic iron oxide nanoparticles (SPIONs) are inorganic particles that can be functionalised as targeted drug vehicles with a stealth polymer coating and a specific antibody tag to recognise appropriate antigen expressing cells. Our aim is to develop and investigate the effects of SPIONs capable of targeted cell death of pancreatic cells by release of its chemotherapy payload. Methods: Micellar SPIONs, incorporating a gemcitabine pro-drug, conjugated to isotype and anti-CA19.9 antibodies (NP:CA19.9) were manufactured using self assembly methodology. Cellular uptake was assessed using transmission electron and co-localisation fluorescent microscopy. Antigen expression of cell lines was determined using indirect immunofluorescence. Antibody targeting was assessed using EZ4U cytotoxicity assay in BxPC-3 (Ca-19-9 +ve) and MiaPaCa-2 (Ca-19-9-ve) cell lines. Results: Endocytosis of the SPIONs was demonstrated by their presence in endosomes and corroborated by colocalisation analysis (Manders coefficient = 0.92). The IC50 of gemcitabine was significantly improved using a nanohybrid attached with specific antibody targeting in BxPC-3 cells (10.245Î 1 / 4 M vs 5.143Î 1 / 4 M) [p < 0.001] but absent in MiaPaCa-2 cells (2.322Î 1 / 4 M vs 2.486Î 1 / 4 M) [n = 3]. Conclusions: We have developed a novel nanohybrid to target antigen expressing pancreatic cancer cells using a specific antibody tag. When loaded with modified gemcitabine, these SPIONs act as pH-triggered delivery vehicles capable of intracellular drug release. This could reduce off target effects leading to increased chemotherapy agent efficacy and offer the prospect for new treatments in pancreatic cancer.

Research paper thumbnail of Risk factors associated with pancreatic fistulas after pancreatoduodenectomy: development and internal validation of a preoperative nomogram

Background Most complications after pancreatoduodenectomy (PD) are due to pancreatic fistula (PF)... more Background Most complications after pancreatoduodenectomy (PD) are due to pancreatic fistula (PF). Therefore, predicting PF is important to individualize treatment. The aim of this study is to develop a preoperative nomogram to predict PF after PD. Methods From January 2009 to January 2018, patients that underwent PD were reviewed. After univariate analyses, variables with p < 0.1 were selected for a multivariate analysis. Variables with p < 0.05 were then included in the nomogram, which was internally validated in a different set of patients. Results Out of 180 patients evaluated, 19.4% experienced PF. Risk factors for PF were male gender (OR = 2.89), higher BMI (OR = 1.14) and pancreatic duct diameter ≤ 3 mm (OR = 3.52). Weight loss greater than 10% was protective against PF (OR = 0.16). Using these four variables, a preoperative nomogram was built. The nomogram performed well in the validation set (n = 82 patients, 25.6% with PF) with an area under the ROC curve of 0.798. C...

Research paper thumbnail of Hexafluoroisopropanol decreases liver ischemia–reperfusion injury by downregulation of high mobility group box‐1 protein

Pharmacology Research & Perspectives

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.