Fernando Maluenda - Academia.edu (original) (raw)
Papers by Fernando Maluenda
PubMed, Oct 1, 1993
During a 20-year period from 1970 to 1991, a total of 30,800 patients underwent biliary tract sur... more During a 20-year period from 1970 to 1991, a total of 30,800 patients underwent biliary tract surgery at the Department of Surgery, University of Chile Clinical Hospital. Of these, seven female adults with a mean age of 39.7 years (range 29 to 54) were considered for analysis in this study. The results of the Heineke-Mikulicz type choledochoplasty repair in patients with short localized strictures of the biliary tract were analyzed in these patients. In six cases, the repair was performed at a mean time of 20 months after cholecystectomy and accidental injury of the common bile duct; in one case it was carried out during cholecystectomy and repair of a Mirizzi type II cholecysto-hepatic fistula. This patient remained asymptomatic during a follow-up of 120 months. Of the six cases on whom choledochoplasty was performed as treatment of short strictures, five patients (83%) developed a new stricture at a mean time of 14 months after surgery; a hepatico-jejunostomy was performed in all. After this procedure, only one patient was re-operated again, and all remained asymptomatic long after surgery. We believe that this Heineke-Mikulicz type choledochoplasty, which has been recommended in short distal strictures, is not advisable as a definitive surgical repair for this kind of stricture.
PubMed, Aug 1, 1991
The prevalence of gallbladder cancer in 10,468 cholecystectomy patients was studied: 3.4% of the ... more The prevalence of gallbladder cancer in 10,468 cholecystectomy patients was studied: 3.4% of the female and only 1.32% of the male population had gallbladder cancer (p < 0.001). The female population had 2.7 times more cholelithiasis, and 7.9 times more cancer than the male population. Cancer incidence increases progressively with age, specially after the 5th decade.
PubMed, Mar 1, 1996
Background/aims: This prospective study evaluates the peristaltic activity of the thoracic esopha... more Background/aims: This prospective study evaluates the peristaltic activity of the thoracic esophagus in a group of patients with gastroesophageal reflux disease grouping them according to the endoscopic findings. Materials and methods: The peristaltic activity and the manometric features of the lower esophageal sphincter were prospectively evaluated in 109 controls and 321 patients with reflux esophagitis, divided according to the degree of endoscopic esophagitis employing Savary's classification. Results: Gastro esophageal sphincter pressure was progressively lower according to the severity of the tissue damage. Motor peristaltic activity of the thoracic esophagus measured by several different parameters was significantly altered in Grade IV esophagitis compared to other groups (p < 0.01). The manometric changes were more pronounced at the distal esophagus compared to the proximal esophagus. The percentage of patients with severe motor disturbances, defined as lower esophageal sphincter (LES) pressure less than 6 mm, less than 50% of peristaltic waves after swallowing and amplitude of contractile waves of less than 50 mmHg were significantly greater in patients with severe esophageal injury (p < 0.001). Conclusion: Gastroesophageal esophageal reflux may exhibit a wide spectrum of motor disturbances in the distal part of the esophagus even before the presence of the tissue damage, but it increases in proportion to the severity of endoscopic esophagitis.
PubMed, Nov 1, 1995
Background/aims: The presence of aerobic and/or anaerobic bacteria in the liver parenchyma, gallb... more Background/aims: The presence of aerobic and/or anaerobic bacteria in the liver parenchyma, gallbladder bile, and common bile duct was investigated. Materials and methods: There were 15 control subjects, 32 cases with symptomatic gallstones, 16 patients with common bile duct stones without acute cholangitis and 8 cases with common bile duct stones with an acute suppurative cholangitis. Results: No bacteria were isolated in controls. The percentage of positive cultures in liver parenchyma increased in proportion to the severity of the biliary tract disease. There was no clear correlation between normal and altered hepatic histology and the presence or absence of bacteria except in patients with acute cholangitis. Conclusions: When biliary tract obstruction is present, the biliary tract is more vulnerable to invasion of bacteria and therefore increases the chance of spread into the liver parenchyma.
Revista Chilena De Cirugia, Jun 1, 2006
Background: The prevalence of morbid obesity is increasing in Chile. Surgery is a therapeutic wea... more Background: The prevalence of morbid obesity is increasing in Chile. Surgery is a therapeutic weapon with undisputed effectiveness, but not exempt of complications. Aim: To evaluate the mortality of bariatric surgery in Chile. Material and Methods: Ten groups, working at private clinics were invited to present their results with bariatric surgery in a meeting. The reported results are presented in this paper. Results: During the last five years, 4040 gastric bypass and 896 gastric banding have been performed in the ten centers presenting their results. The global mortality of gastric bypass was 0.32%. Pulmonary embolism was the cause of mortality in more than 50% of cases. Complication rate varied between 2.3 and 20%. The reoperation rate varied between 1.6 and 11.6%. There was no mortality associated to gastric banding. Conclusions: Mortality and complications associated to bariatric surgery in Chile are comparable with the figures reported abroad.
PubMed, Feb 1, 1989
The late results of 43 patients with accidental section of the common bile duct are presented. In... more The late results of 43 patients with accidental section of the common bile duct are presented. Injuries located high at the hepatic duct were three times more frequent than those located more distally. A complete section occurred in 36 while incomplete section was observed in seven patients. The final results of end to end repair revealed good late results in eight while 29 had a benign stricture four years postoperatively.
PubMed, Jun 1, 1989
Acute suppurative cholangitis is a serious complication in extrahepatic biliary tract obstruction... more Acute suppurative cholangitis is a serious complication in extrahepatic biliary tract obstruction. Bacteriological studies have shown that in these patients the bile cultures usually present several kinds of bacteria, especially Gram-negative aerobic bacteria such as E. coli and Klebsiella sp. The mortality rate in our patients with common bile duct stones and acute suppurative cholangitis is enhanced 5- to 10-fold. The aim of the present study was to analyse the bacterial properties of choledochal bile in a large number of patients with common bile duct stones, with or without acute suppurative cholangitis, and to determine the sensitivity of the isolated bacteria to several antibiotics used in clinical practice. The greatest sensitivity of the bacteria isolated from the common bile duct was seen for aminoglycosides (gentamicin and amikacin) and for cephalosporins, especially of the third generation (cefotaxime, ceftazidime, ceftriaxone and cefoperazone). Ampicillin showed a low sensitivity rate. The appropriate selection of the antibiotics used in acute suppurative cholangitis depends not only on the concentration of the antibiotic in the bile; a high plasma concentration is even more important to control the septic manifestations. A high excretion to the bile can affect the intestinal flora, leading to diarrhea (e. g. with cefoperazone). Ampicillin has been giving contradictory results in respect of bile and plasma concentrations. Gentamicin attains 30-40% of the plasma concentration in the bile, but persists for as long as 8 hours with excellent sensitivity and clinical efficacy. Amikacin reaches 44% of the plasma concentration with a very high sensitivity (96%).(ABSTRACT TRUNCATED AT 250 WORDS)
Revista Medica De Chile, 1996
Background: Laparoscopic antireflux surgery is a minimally invasive procedure that should have si... more Background: Laparoscopic antireflux surgery is a minimally invasive procedure that should have similar results than classical surgical treatment. Aim: To report the results of a prospective study of laparoscopic antireflux surgery in patients with gastroesophageal reflux. Patients and methods: Thirty two patients with gastroesophageal reflux and without Barret's esophagus, were subjected to endoscopy, manometry and measurement of intraesophageal pH before and after laparoscopic surgery. Results: There were no postoperative deaths or complications. Gastroesophageal sphincter pressure and abdominal sphincter length increased from 9.1 ± 3.9 to 13.0 ± 3.5 mm Hg and from 8.1 ± 6.2 to 13.5 ± 5.4 cm after surgery (p<0.01). There was a decrease in acid reflux in 82% of patients. Conclusions: laparoscopic antireflux surgery reproduces exactly the results of open surgical procedures
Diseases of The Esophagus, Oct 1, 1996
Revista Chilena De Cirugia, Jun 1, 2008
Se describe una paciente de 16 años portadora de un tumor solido pseudopapilar del páncreas. (TSP... more Se describe una paciente de 16 años portadora de un tumor solido pseudopapilar del páncreas. (TSP) La paciente fue referida a nuestro hospital por un cuadro de dolor abdominal y la existencia a la tomografía computada de una masa de contenido heterogéneo en la cabeza del páncreas. La paciente fue sometida a una resección pancreatoduodenal , extirpando una masa que pudo ser resecada con bordes negativos. La paciente evoluciona en buena forma en su post operatorio. El estudio histológico confirmó la existencia de un tumor solido pseudopapilar del páncreas.
European Surgery-acta Chirurgica Austriaca, Feb 1, 2014
Single-incision laparoscopic sleeve gastrectomy: initial experience in 20 patients and 2-year fol... more Single-incision laparoscopic sleeve gastrectomy: initial experience in 20 patients and 2-year follow-up 1 3 Summary Background The transumbilical route began being clinically feasible with or without unique access devices. Setting The setting for this study was a private practice at Clínica Las Condes, Santiago, Chile. Objective The objective was to describe our experience performing a laparoscopic sleeve gastrectomy (LSG) via transumbilical route using a single-port access device in addition to standard laparoscopic instruments. Method A prospective nonrandomized protocol was applied to patients fulfilling the following inclusion criteria: to have been medically indicated for an LSG, to have a body mass index (BMI) of less than or equal to 40 kg/ m 2 , and the distance between the xiphoid appendix and umbilicus should be less than 22 cm. All patients were female with a median (p50) age of 34.5 (ranging from 21 to 57) years, a median weight of 92 (ranging from 82.5 to 113) kg, and a median BMI of 35.1 (ranging from 30.5 to 40) kg/m 2. The device insertion technique, the gastrectomy, and postoperative management are described. Results LSG via transumbilical route was successfully carried out in 19 of the 20 patients in whom the procedure was performed; one patient had to be converted to a conventional laparoscopic procedure. Mean operating time was 127 (ranging from 90 to 170) min. On the second postoperative day, all patients were assessed through an upper gastrointestinal barium-contrasted radiological series. There was neither morbidity nor mortality in this group. Excess weight loss at 25 months after surgery was 114 %. Conclusions Single-port LSG can be successfully performed in selected obese patients with a BMI of less than 40 kg/m 2 using traditional laparoscopic instruments. The technique allows performing a safe and effective vertical gastrectomy.
Revista Chilena De Cirugia, 1998
Resumo: Se realizó un estudio prospectivo y controlado en 464 pacientes con colelitiasis, sometid... more Resumo: Se realizó un estudio prospectivo y controlado en 464 pacientes con colelitiasis, sometidos a colecistectomía y colangiografía intravenosa rutinaria para determinar la real necesidad del uso rutinario de la colangiografía intraoperatoria (CIO) y los criterios o ...
Revista Medica De Chile, 2008
Revista Chilena De Cirugia, Dec 1, 2012
Mortality associated with open and laparoscopic cholecystectomy Background: Laparoscopic cholecys... more Mortality associated with open and laparoscopic cholecystectomy Background: Laparoscopic cholecystectomy is nowadays the standard surgical treatment for cholelithiasis. Aim: To determine surgical mortality of laparoscopic cholecystectomy as compared with the open procedure. Material and Methods: Review of medical records of all patients subjected to open or laparoscopic surgery in a surgical service of a clinical hospital, in a period of 20 years. Results: The records of 26.441 patients were reviewed. The figures for overall, open and laparoscopic surgery mortality were 0.16, 0.39 and 0.07% respectively. Only two of the 43 deceased patients, died as a direct complication of the surgical procedure. In the rest, the causes of mortality were underlying severe medical conditions. Conclusions: Laparoscopic cholecystectomy has a very low mortality that depends mostly on underlying medical conditions and advanced age.
PubMed, Jun 1, 1989
Chile is the country with the highest incidence of gallstone disease in the world. Nearly 44% of ... more Chile is the country with the highest incidence of gallstone disease in the world. Nearly 44% of the women and 25% of the men over 20 years of age have gallstones. Biliary tract surgery accounts for about 35% of all the operations performed in Chilean general hospitals. The present paper aims at assessing the risk factors associated with a higher mortality in patients over 70 years of age subjected to elective or emergency surgery for gallstones or common bile duct stones. No specific factors of mortality were found in the group of elderly patients subjected to elective cholecystectomy. There was also no correlation between types of cholecystitis and postoperative mortality. However, acute suppurative cholangitis made the postoperative mortality rate increase almost 20-fold in patients with common bile duct stones. The mortality also shows a steep increase (up to 12%) if cholecystectomy is performed in acute cholecystitis. Cholecystostomy seems to be associated with a low mortality risk and hence should be appropriate in exceptionally high-risk patients, but is not considered useful by the authors in necrotic or gangrenous cholecystitis, or in cases with common bile duct stones and cholangitis. Postoperative mortality in patients submitted to cholecystectomy alone seems to depend exclusively on the concomitant presence of medical complications, mainly of a respiratory and cardiovascular nature. Septic complications are important causes of postoperative mortality in emergency cholecystectomy. Patients at high surgical risk are those suspected of cholangitis, those over 80 years of age, and those suffering from Charcot's triad, anemia, uremia, leukocytosis, hyperbilirubinemia or hypoprothrombinemia; in these, an endoscopic procedure could be chosen.
Revista medica de Chile, 1991
The prevalence of gallbladder cancer in 10,468 cholecystectomy patients was studied: 3.4% of the ... more The prevalence of gallbladder cancer in 10,468 cholecystectomy patients was studied: 3.4% of the female and only 1.32% of the male population had gallbladder cancer (p < 0.001). The female population had 2.7 times more cholelithiasis, and 7.9 times more cancer than the male population. Cancer incidence increases progressively with age, specially after the 5th decade.
Journal of Clinical Oncology, 2006
14136 Background: Metastatic gallbladder cancer (MGBC) is a rapidly progressive disease, orphan o... more 14136 Background: Metastatic gallbladder cancer (MGBC) is a rapidly progressive disease, orphan of treatment; its median survival is only 3 to 4 months. Since 1999 we had demonstrated that gemcitabine (Gem) and gemcitabine-cisplatin (Gem-plat) are active regimens against this disease, but median survival increases to only 8 months. We had seen some complete responses and cases with impressive partial responses, but all of them are transients, recurrence appears in all pts. The benefit of combining CHTx and surgery had not been tested in MGBC, but has demonstrated promising results in others GI cancers. Methods: A retrospective analysis was performed in data from 9 patients (pts) who had liver resection for MGBC. Gem o gem-plat was given to all patients. Between September 1999 and July 2005 we had included more than 70 pts in two trials and others 25 pts had been treated outside of clinical trials. Among then, 9 patients with metastases from MGBC who were treated with Gem ± plat, wer...
Molecular and cellular endocrinology, Mar 15, 2017
Hyperandrogenic states and obesity in women are associated with insulin-resistance. Androgens red... more Hyperandrogenic states and obesity in women are associated with insulin-resistance. Androgens reduce glucose uptake in adipose cells and increase TNFα production in peripheral monocytes. Inflammatory cytokines have a known detrimental effect on insulin resistance. The aim of the present study was to explore the role of testosterone in local cytokine production in visceral adipose tissue from women of reproductive age. Twenty-four women 18-40 years old, undergoing elective abdominal surgery for benign and non-inflammatory conditions, were recruited for the study. Women with clinical hyperandrogenism, diabetes, hepatic or renal dysfunction, hypothyroidism, BMI> 40 or drugs known to interfere with hormonal levels or fat metabolism were excluded. Women were classified into two groups according to BMI, non-obese (NO; BMI < 30) and obese (O; BMI 30-40). A basal blood sample was drawn at the time of surgery for the measurement of glucose, insulin, total testosterone, lipid profile an...
Metabolic syndrome and related disorders, Mar 11, 2017
The mechanism leading to the development of metabolic complications in obese individuals is not f... more The mechanism leading to the development of metabolic complications in obese individuals is not fully understood. Thus, the objective of this study was to examine differences in insulin resistance, inflammation, cytokine and adipokine levels, and expression of selected genes across obese individuals with different number of metabolic syndrome (MetS) components. Forty obese individuals who underwent bariatric surgery, divided in three groups based on the number of components of MetS, in addition to abdominal obesity (0, 1, and 2-3 additional components), were studied. Levels of inflammatory proteins, insulin resistance, cytokines, adipokines, and gene expression in subcutaneous (SAT) and visceral adipose tissue (VAT) were compared. There was a significantly higher expression of MYD88 in SAT among those with more components of MetS (P = 0.008). In SAT, but not in VAT, MYD88 expression was significantly correlated with toll-like receptor 4 expression (r = 0.7, P < 0.05). Expression ...
PubMed, Oct 1, 1993
During a 20-year period from 1970 to 1991, a total of 30,800 patients underwent biliary tract sur... more During a 20-year period from 1970 to 1991, a total of 30,800 patients underwent biliary tract surgery at the Department of Surgery, University of Chile Clinical Hospital. Of these, seven female adults with a mean age of 39.7 years (range 29 to 54) were considered for analysis in this study. The results of the Heineke-Mikulicz type choledochoplasty repair in patients with short localized strictures of the biliary tract were analyzed in these patients. In six cases, the repair was performed at a mean time of 20 months after cholecystectomy and accidental injury of the common bile duct; in one case it was carried out during cholecystectomy and repair of a Mirizzi type II cholecysto-hepatic fistula. This patient remained asymptomatic during a follow-up of 120 months. Of the six cases on whom choledochoplasty was performed as treatment of short strictures, five patients (83%) developed a new stricture at a mean time of 14 months after surgery; a hepatico-jejunostomy was performed in all. After this procedure, only one patient was re-operated again, and all remained asymptomatic long after surgery. We believe that this Heineke-Mikulicz type choledochoplasty, which has been recommended in short distal strictures, is not advisable as a definitive surgical repair for this kind of stricture.
PubMed, Aug 1, 1991
The prevalence of gallbladder cancer in 10,468 cholecystectomy patients was studied: 3.4% of the ... more The prevalence of gallbladder cancer in 10,468 cholecystectomy patients was studied: 3.4% of the female and only 1.32% of the male population had gallbladder cancer (p < 0.001). The female population had 2.7 times more cholelithiasis, and 7.9 times more cancer than the male population. Cancer incidence increases progressively with age, specially after the 5th decade.
PubMed, Mar 1, 1996
Background/aims: This prospective study evaluates the peristaltic activity of the thoracic esopha... more Background/aims: This prospective study evaluates the peristaltic activity of the thoracic esophagus in a group of patients with gastroesophageal reflux disease grouping them according to the endoscopic findings. Materials and methods: The peristaltic activity and the manometric features of the lower esophageal sphincter were prospectively evaluated in 109 controls and 321 patients with reflux esophagitis, divided according to the degree of endoscopic esophagitis employing Savary's classification. Results: Gastro esophageal sphincter pressure was progressively lower according to the severity of the tissue damage. Motor peristaltic activity of the thoracic esophagus measured by several different parameters was significantly altered in Grade IV esophagitis compared to other groups (p < 0.01). The manometric changes were more pronounced at the distal esophagus compared to the proximal esophagus. The percentage of patients with severe motor disturbances, defined as lower esophageal sphincter (LES) pressure less than 6 mm, less than 50% of peristaltic waves after swallowing and amplitude of contractile waves of less than 50 mmHg were significantly greater in patients with severe esophageal injury (p < 0.001). Conclusion: Gastroesophageal esophageal reflux may exhibit a wide spectrum of motor disturbances in the distal part of the esophagus even before the presence of the tissue damage, but it increases in proportion to the severity of endoscopic esophagitis.
PubMed, Nov 1, 1995
Background/aims: The presence of aerobic and/or anaerobic bacteria in the liver parenchyma, gallb... more Background/aims: The presence of aerobic and/or anaerobic bacteria in the liver parenchyma, gallbladder bile, and common bile duct was investigated. Materials and methods: There were 15 control subjects, 32 cases with symptomatic gallstones, 16 patients with common bile duct stones without acute cholangitis and 8 cases with common bile duct stones with an acute suppurative cholangitis. Results: No bacteria were isolated in controls. The percentage of positive cultures in liver parenchyma increased in proportion to the severity of the biliary tract disease. There was no clear correlation between normal and altered hepatic histology and the presence or absence of bacteria except in patients with acute cholangitis. Conclusions: When biliary tract obstruction is present, the biliary tract is more vulnerable to invasion of bacteria and therefore increases the chance of spread into the liver parenchyma.
Revista Chilena De Cirugia, Jun 1, 2006
Background: The prevalence of morbid obesity is increasing in Chile. Surgery is a therapeutic wea... more Background: The prevalence of morbid obesity is increasing in Chile. Surgery is a therapeutic weapon with undisputed effectiveness, but not exempt of complications. Aim: To evaluate the mortality of bariatric surgery in Chile. Material and Methods: Ten groups, working at private clinics were invited to present their results with bariatric surgery in a meeting. The reported results are presented in this paper. Results: During the last five years, 4040 gastric bypass and 896 gastric banding have been performed in the ten centers presenting their results. The global mortality of gastric bypass was 0.32%. Pulmonary embolism was the cause of mortality in more than 50% of cases. Complication rate varied between 2.3 and 20%. The reoperation rate varied between 1.6 and 11.6%. There was no mortality associated to gastric banding. Conclusions: Mortality and complications associated to bariatric surgery in Chile are comparable with the figures reported abroad.
PubMed, Feb 1, 1989
The late results of 43 patients with accidental section of the common bile duct are presented. In... more The late results of 43 patients with accidental section of the common bile duct are presented. Injuries located high at the hepatic duct were three times more frequent than those located more distally. A complete section occurred in 36 while incomplete section was observed in seven patients. The final results of end to end repair revealed good late results in eight while 29 had a benign stricture four years postoperatively.
PubMed, Jun 1, 1989
Acute suppurative cholangitis is a serious complication in extrahepatic biliary tract obstruction... more Acute suppurative cholangitis is a serious complication in extrahepatic biliary tract obstruction. Bacteriological studies have shown that in these patients the bile cultures usually present several kinds of bacteria, especially Gram-negative aerobic bacteria such as E. coli and Klebsiella sp. The mortality rate in our patients with common bile duct stones and acute suppurative cholangitis is enhanced 5- to 10-fold. The aim of the present study was to analyse the bacterial properties of choledochal bile in a large number of patients with common bile duct stones, with or without acute suppurative cholangitis, and to determine the sensitivity of the isolated bacteria to several antibiotics used in clinical practice. The greatest sensitivity of the bacteria isolated from the common bile duct was seen for aminoglycosides (gentamicin and amikacin) and for cephalosporins, especially of the third generation (cefotaxime, ceftazidime, ceftriaxone and cefoperazone). Ampicillin showed a low sensitivity rate. The appropriate selection of the antibiotics used in acute suppurative cholangitis depends not only on the concentration of the antibiotic in the bile; a high plasma concentration is even more important to control the septic manifestations. A high excretion to the bile can affect the intestinal flora, leading to diarrhea (e. g. with cefoperazone). Ampicillin has been giving contradictory results in respect of bile and plasma concentrations. Gentamicin attains 30-40% of the plasma concentration in the bile, but persists for as long as 8 hours with excellent sensitivity and clinical efficacy. Amikacin reaches 44% of the plasma concentration with a very high sensitivity (96%).(ABSTRACT TRUNCATED AT 250 WORDS)
Revista Medica De Chile, 1996
Background: Laparoscopic antireflux surgery is a minimally invasive procedure that should have si... more Background: Laparoscopic antireflux surgery is a minimally invasive procedure that should have similar results than classical surgical treatment. Aim: To report the results of a prospective study of laparoscopic antireflux surgery in patients with gastroesophageal reflux. Patients and methods: Thirty two patients with gastroesophageal reflux and without Barret's esophagus, were subjected to endoscopy, manometry and measurement of intraesophageal pH before and after laparoscopic surgery. Results: There were no postoperative deaths or complications. Gastroesophageal sphincter pressure and abdominal sphincter length increased from 9.1 ± 3.9 to 13.0 ± 3.5 mm Hg and from 8.1 ± 6.2 to 13.5 ± 5.4 cm after surgery (p<0.01). There was a decrease in acid reflux in 82% of patients. Conclusions: laparoscopic antireflux surgery reproduces exactly the results of open surgical procedures
Diseases of The Esophagus, Oct 1, 1996
Revista Chilena De Cirugia, Jun 1, 2008
Se describe una paciente de 16 años portadora de un tumor solido pseudopapilar del páncreas. (TSP... more Se describe una paciente de 16 años portadora de un tumor solido pseudopapilar del páncreas. (TSP) La paciente fue referida a nuestro hospital por un cuadro de dolor abdominal y la existencia a la tomografía computada de una masa de contenido heterogéneo en la cabeza del páncreas. La paciente fue sometida a una resección pancreatoduodenal , extirpando una masa que pudo ser resecada con bordes negativos. La paciente evoluciona en buena forma en su post operatorio. El estudio histológico confirmó la existencia de un tumor solido pseudopapilar del páncreas.
European Surgery-acta Chirurgica Austriaca, Feb 1, 2014
Single-incision laparoscopic sleeve gastrectomy: initial experience in 20 patients and 2-year fol... more Single-incision laparoscopic sleeve gastrectomy: initial experience in 20 patients and 2-year follow-up 1 3 Summary Background The transumbilical route began being clinically feasible with or without unique access devices. Setting The setting for this study was a private practice at Clínica Las Condes, Santiago, Chile. Objective The objective was to describe our experience performing a laparoscopic sleeve gastrectomy (LSG) via transumbilical route using a single-port access device in addition to standard laparoscopic instruments. Method A prospective nonrandomized protocol was applied to patients fulfilling the following inclusion criteria: to have been medically indicated for an LSG, to have a body mass index (BMI) of less than or equal to 40 kg/ m 2 , and the distance between the xiphoid appendix and umbilicus should be less than 22 cm. All patients were female with a median (p50) age of 34.5 (ranging from 21 to 57) years, a median weight of 92 (ranging from 82.5 to 113) kg, and a median BMI of 35.1 (ranging from 30.5 to 40) kg/m 2. The device insertion technique, the gastrectomy, and postoperative management are described. Results LSG via transumbilical route was successfully carried out in 19 of the 20 patients in whom the procedure was performed; one patient had to be converted to a conventional laparoscopic procedure. Mean operating time was 127 (ranging from 90 to 170) min. On the second postoperative day, all patients were assessed through an upper gastrointestinal barium-contrasted radiological series. There was neither morbidity nor mortality in this group. Excess weight loss at 25 months after surgery was 114 %. Conclusions Single-port LSG can be successfully performed in selected obese patients with a BMI of less than 40 kg/m 2 using traditional laparoscopic instruments. The technique allows performing a safe and effective vertical gastrectomy.
Revista Chilena De Cirugia, 1998
Resumo: Se realizó un estudio prospectivo y controlado en 464 pacientes con colelitiasis, sometid... more Resumo: Se realizó un estudio prospectivo y controlado en 464 pacientes con colelitiasis, sometidos a colecistectomía y colangiografía intravenosa rutinaria para determinar la real necesidad del uso rutinario de la colangiografía intraoperatoria (CIO) y los criterios o ...
Revista Medica De Chile, 2008
Revista Chilena De Cirugia, Dec 1, 2012
Mortality associated with open and laparoscopic cholecystectomy Background: Laparoscopic cholecys... more Mortality associated with open and laparoscopic cholecystectomy Background: Laparoscopic cholecystectomy is nowadays the standard surgical treatment for cholelithiasis. Aim: To determine surgical mortality of laparoscopic cholecystectomy as compared with the open procedure. Material and Methods: Review of medical records of all patients subjected to open or laparoscopic surgery in a surgical service of a clinical hospital, in a period of 20 years. Results: The records of 26.441 patients were reviewed. The figures for overall, open and laparoscopic surgery mortality were 0.16, 0.39 and 0.07% respectively. Only two of the 43 deceased patients, died as a direct complication of the surgical procedure. In the rest, the causes of mortality were underlying severe medical conditions. Conclusions: Laparoscopic cholecystectomy has a very low mortality that depends mostly on underlying medical conditions and advanced age.
PubMed, Jun 1, 1989
Chile is the country with the highest incidence of gallstone disease in the world. Nearly 44% of ... more Chile is the country with the highest incidence of gallstone disease in the world. Nearly 44% of the women and 25% of the men over 20 years of age have gallstones. Biliary tract surgery accounts for about 35% of all the operations performed in Chilean general hospitals. The present paper aims at assessing the risk factors associated with a higher mortality in patients over 70 years of age subjected to elective or emergency surgery for gallstones or common bile duct stones. No specific factors of mortality were found in the group of elderly patients subjected to elective cholecystectomy. There was also no correlation between types of cholecystitis and postoperative mortality. However, acute suppurative cholangitis made the postoperative mortality rate increase almost 20-fold in patients with common bile duct stones. The mortality also shows a steep increase (up to 12%) if cholecystectomy is performed in acute cholecystitis. Cholecystostomy seems to be associated with a low mortality risk and hence should be appropriate in exceptionally high-risk patients, but is not considered useful by the authors in necrotic or gangrenous cholecystitis, or in cases with common bile duct stones and cholangitis. Postoperative mortality in patients submitted to cholecystectomy alone seems to depend exclusively on the concomitant presence of medical complications, mainly of a respiratory and cardiovascular nature. Septic complications are important causes of postoperative mortality in emergency cholecystectomy. Patients at high surgical risk are those suspected of cholangitis, those over 80 years of age, and those suffering from Charcot's triad, anemia, uremia, leukocytosis, hyperbilirubinemia or hypoprothrombinemia; in these, an endoscopic procedure could be chosen.
Revista medica de Chile, 1991
The prevalence of gallbladder cancer in 10,468 cholecystectomy patients was studied: 3.4% of the ... more The prevalence of gallbladder cancer in 10,468 cholecystectomy patients was studied: 3.4% of the female and only 1.32% of the male population had gallbladder cancer (p < 0.001). The female population had 2.7 times more cholelithiasis, and 7.9 times more cancer than the male population. Cancer incidence increases progressively with age, specially after the 5th decade.
Journal of Clinical Oncology, 2006
14136 Background: Metastatic gallbladder cancer (MGBC) is a rapidly progressive disease, orphan o... more 14136 Background: Metastatic gallbladder cancer (MGBC) is a rapidly progressive disease, orphan of treatment; its median survival is only 3 to 4 months. Since 1999 we had demonstrated that gemcitabine (Gem) and gemcitabine-cisplatin (Gem-plat) are active regimens against this disease, but median survival increases to only 8 months. We had seen some complete responses and cases with impressive partial responses, but all of them are transients, recurrence appears in all pts. The benefit of combining CHTx and surgery had not been tested in MGBC, but has demonstrated promising results in others GI cancers. Methods: A retrospective analysis was performed in data from 9 patients (pts) who had liver resection for MGBC. Gem o gem-plat was given to all patients. Between September 1999 and July 2005 we had included more than 70 pts in two trials and others 25 pts had been treated outside of clinical trials. Among then, 9 patients with metastases from MGBC who were treated with Gem ± plat, wer...
Molecular and cellular endocrinology, Mar 15, 2017
Hyperandrogenic states and obesity in women are associated with insulin-resistance. Androgens red... more Hyperandrogenic states and obesity in women are associated with insulin-resistance. Androgens reduce glucose uptake in adipose cells and increase TNFα production in peripheral monocytes. Inflammatory cytokines have a known detrimental effect on insulin resistance. The aim of the present study was to explore the role of testosterone in local cytokine production in visceral adipose tissue from women of reproductive age. Twenty-four women 18-40 years old, undergoing elective abdominal surgery for benign and non-inflammatory conditions, were recruited for the study. Women with clinical hyperandrogenism, diabetes, hepatic or renal dysfunction, hypothyroidism, BMI> 40 or drugs known to interfere with hormonal levels or fat metabolism were excluded. Women were classified into two groups according to BMI, non-obese (NO; BMI < 30) and obese (O; BMI 30-40). A basal blood sample was drawn at the time of surgery for the measurement of glucose, insulin, total testosterone, lipid profile an...
Metabolic syndrome and related disorders, Mar 11, 2017
The mechanism leading to the development of metabolic complications in obese individuals is not f... more The mechanism leading to the development of metabolic complications in obese individuals is not fully understood. Thus, the objective of this study was to examine differences in insulin resistance, inflammation, cytokine and adipokine levels, and expression of selected genes across obese individuals with different number of metabolic syndrome (MetS) components. Forty obese individuals who underwent bariatric surgery, divided in three groups based on the number of components of MetS, in addition to abdominal obesity (0, 1, and 2-3 additional components), were studied. Levels of inflammatory proteins, insulin resistance, cytokines, adipokines, and gene expression in subcutaneous (SAT) and visceral adipose tissue (VAT) were compared. There was a significantly higher expression of MYD88 in SAT among those with more components of MetS (P = 0.008). In SAT, but not in VAT, MYD88 expression was significantly correlated with toll-like receptor 4 expression (r = 0.7, P < 0.05). Expression ...