Ramon Gomez | Tecnológico de Monterrey (original) (raw)

Papers by Ramon Gomez

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA100 TM SYSTEM 1 . 1 Footnote: Not available for sale in the USA; pending 510(k) clearance. Presented in part at the XVIth meeting of the I.S.T.H. (Florence, 1997)

Thrombosis Research, 1997

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA-100TM SYSTEM

Thrombosis Research, 1997

Research paper thumbnail of Long-term Biliary Complications after Liver Surgery Leading to Liver Transplantation

World Journal of Surgery, 2001

Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life ... more Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life and may lead to secondary biliary cirrhosis with liver failure. We reviewed our experience with chronic biliary complications after surgical treatment of various diseases that at the end needed a liver transplantation. Twelve patients with previous biliary surgery developed secondary biliary cholangitis, secondary biliary cirrhosis, or both. Seven had surgery for liver hydatid disease by Echinococcus granulosus, another four had complicated biliary surgery unrelated to hydatid disease, and one had a history of a traffic accident with liver trauma and hepatectomy with chronic biliary fistula. The repeated cholangitis attacks and in two cases of hydatid disease the development of biliary-bronchial fistulas made these patients' lives miserable. All had had previous surgical procedures that made the transplantation procedure more difficult. Nevertheless, patient survival and graft actuarial survival after liver replacement were 75.0% and 69.2%, respectively, at 5 years.

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA100 TM SYSTEM 1 . 1 Footnote: Not available for sale in the USA; pending 510(k) clearance. Presented in part at the XVIth meeting of the I.S.T.H. (Florence, 1997)

Thrombosis Research, 1997

Research paper thumbnail of Advanced donor age increases the risk of severe recurrent hepatitis C after liver transplantation

Transplant International, 2005

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA-100TM SYSTEM

Thrombosis Research, 1997

Research paper thumbnail of Long-term Biliary Complications after Liver Surgery Leading to Liver Transplantation

World Journal of Surgery, 2001

Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life ... more Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life and may lead to secondary biliary cirrhosis with liver failure. We reviewed our experience with chronic biliary complications after surgical treatment of various diseases that at the end needed a liver transplantation. Twelve patients with previous biliary surgery developed secondary biliary cholangitis, secondary biliary cirrhosis, or both. Seven had surgery for liver hydatid disease by Echinococcus granulosus, another four had complicated biliary surgery unrelated to hydatid disease, and one had a history of a traffic accident with liver trauma and hepatectomy with chronic biliary fistula. The repeated cholangitis attacks and in two cases of hydatid disease the development of biliary-bronchial fistulas made these patients' lives miserable. All had had previous surgical procedures that made the transplantation procedure more difficult. Nevertheless, patient survival and graft actuarial survival after liver replacement were 75.0% and 69.2%, respectively, at 5 years.

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA100 TM SYSTEM 1 . 1 Footnote: Not available for sale in the USA; pending 510(k) clearance. Presented in part at the XVIth meeting of the I.S.T.H. (Florence, 1997)

Thrombosis Research, 1997

Research paper thumbnail of Advanced donor age increases the risk of severe recurrent hepatitis C after liver transplantation

Transplant International, 2005

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA-100TM SYSTEM

Thrombosis Research, 1997

Research paper thumbnail of Long-term Biliary Complications after Liver Surgery Leading to Liver Transplantation

World Journal of Surgery, 2001

Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life ... more Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life and may lead to secondary biliary cirrhosis with liver failure. We reviewed our experience with chronic biliary complications after surgical treatment of various diseases that at the end needed a liver transplantation. Twelve patients with previous biliary surgery developed secondary biliary cholangitis, secondary biliary cirrhosis, or both. Seven had surgery for liver hydatid disease by Echinococcus granulosus, another four had complicated biliary surgery unrelated to hydatid disease, and one had a history of a traffic accident with liver trauma and hepatectomy with chronic biliary fistula. The repeated cholangitis attacks and in two cases of hydatid disease the development of biliary-bronchial fistulas made these patients' lives miserable. All had had previous surgical procedures that made the transplantation procedure more difficult. Nevertheless, patient survival and graft actuarial survival after liver replacement were 75.0% and 69.2%, respectively, at 5 years.

Research paper thumbnail of Cardiovascular risk factors in 116 patients 5 years or more after liver transplantation

Transplant International, 2002

Abstract We assessed the cardiovascular risk factors (CVRFs) in 116 stable liver transplant patie... more Abstract We assessed the cardiovascular risk factors (CVRFs) in 116 stable liver transplant patients surviving for 5 years of more (median: 102 months). The prevalence of smokers was 29.3%, hypertension 49.1%, obesity 22.4%, hypercholesterolemia 34.5%, hypertriglyceridemia 11.2%, and hyperhomocysteinemia 57.8%. Diabetes was found in 21.5% of the patients, being more frequent in patients with hepatitis-C-virus infection (31.8% vs 15.3%; P= 0.03). Patients on cyclosporine therapy had a higher prevalence of hypertension, hypercholesterolemia and hyperthomocysteinemia than those treated with tacrolimus. Multivariate analysis showed only an association between cyclosporine therapy and cholesterol concentrations (odds ratio: 1.02; 95% confidence interval (CI): 1.00–1.03; P= 0.01). The prevalence of hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia was lower at the time of the study than at 1 and 3 years after transplantation (P<0.05), probably related to steroid withdrawal. Comparing 87 patients CVRFs with the general Spanish population, we found that the age-gender standardized prevalence ratio was not different: smoking 1.46 (95% CI: 0.88–1.76), obesity 1.16 (95% CI: 0.60–1.44), hypertension 1.55 (95% CI: 0.98–1.81), and hypercholesterolemia 0.64 (95% CI: 0.35–1.90). We conclude that the prevalence of CVRFs in liver transplant patients after 5 years or more is lower that found in the first years after the transplantation, and no different from that found within the Spanish population.

Research paper thumbnail of Surgical resection of biliary tract malignancies after intervention al radiology treatment

Journal of Surgical Oncology, 1993

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Research paper thumbnail of Choledochocholedochostomy Conversion to Hepaticojejunostomy due to Biliary Obstruction in Liver Transplantation

World Journal of Surgery, 2001

Choledochocholedochostomy with tutor (CC-T) or without (CC) is the technique of choice for biliar... more Choledochocholedochostomy with tutor (CC-T) or without (CC) is the technique of choice for biliary reconstruction in orthotopic liver transplantation (OLT), however, its rate of complications is high and does not decrease significantly over the years. Biliary obstruction is the most frequent complication and surgical treatment frequently involves conversion to hepaticojejunostomy (H-J). Out of 412 patients (448 OLTs) analyzed retrospectively, 74 (18%) presented biliary complications and 25 (6%) required conversion to H-J because of biliary obstruction, generally due to anastomotic stenosis (17 patients, 68%). Sixteen out of the 25 presented after the first 3 months, and in two patients, stenosis was secondary to arterial thrombosis. Anastomotic stenosis was more frequent in the CC group than in the CC-T group (9.9% versus 2.6%, p

Research paper thumbnail of Steroid withdrawal is safe and beneficial in stable cyclosporine-treated liver transplant patients

Journal of Hepatology, 1998

In the immunosuppression of orthotopic liver transplant recipients, steroids are used despite the... more In the immunosuppression of orthotopic liver transplant recipients, steroids are used despite their unspecific action and long-term side effects. Few studies have been carried out on steroid withdrawal and many aspects remain to be elucidated. A prospective study was performed to analyse the effect of steroid withdrawal on 86 patients with stable graft function, more than 1 year after orthotopic liver transplant. Thirty patients had chronic hepatitis in the graft. Seventy-two continued with cyclosporine (CsA) and 14 with CsA-azathioprine (AZA) therapy. The follow-up was 23.2 +/- 8.1 months (range 12-52 months). A paired t-test was used for statistical analysis. No acute or chronic rejection occurred, and steroids were not reinstituted. There were no changes in serum transaminase levels, but bilirubin levels decreased (p &amp;amp;lt; 0.01). At the end of the follow-up, we found improvements in blood pressure in hypertensive patients (systolic 156.1 +/- 8.4 mmHg vs. 139.4 +/- 8.7 mmHg, p &amp;amp;lt; 0.001); body weight (72 +/- 13.5 kg vs. 70.8 +/- 13 kg, p &amp;amp;lt; 0.05); serum cholesterol (211.3 +/- 42 mg/dl vs. 191.6 +/- 43.5 mg/dl, p &amp;amp;lt; 0.001) and bone mineral density in lumbar spine (0.823 +/- 0.13 g/cm2 vs. 0.893 +/- 0.135 g/cm2, p &amp;amp;lt; 0.001). Four of ten diabetic patients were no longer insulin-dependent and insulin requirements decreased in the remaining six. No significant biochemical changes were found in patients with hepatitis in the graft, and we found an improvement in inflammatory activity in the nine biopsied patients. Steroid withdrawal with CsA monotherapy is feasible, safe and beneficial in patients who have stable liver graft function 1 year after orthotopic liver transplant. We consider that AZA therapy is not necessary unless drastic reduction of CsA levels is required because of renal dysfunction.

Research paper thumbnail of Diaphragmatic or transdiaphragmatic thoracic involvement in hepatic hydatid disease: Surgical trends and classification

World Journal of Surgery, 1995

We performed a retrospective study of 19 patients who had been operated on for hepatic hydatid di... more We performed a retrospective study of 19 patients who had been operated on for hepatic hydatid disease with diaphragmatic or transdiaphragmatic (D-TD) thoracic involvement chosen from a total of 444 patients who underwent operations for hepatic hydatid disease. In all cases D-TD involvement was confirmed by ultrasonography, CT, or MRI scan. We propose a new classification (grades 1–5) based on the degree of development of D-TD involvement. Before 1984 exposure was obtained by thoracophrenolaparotomy (nine cases) and later by right subcostal incision. Only four patients required atypical pulmonary resection. In 13 cases the diaphragm was repaired, and all 24 hepatic cysts were treated with total (16 cases) or partial (8 cases) cystopericystectomy. There was no operative mortality, and the most serious morbidity consisted of a biliary fistula and a biliobronchial fistula. For treatment of these patients we recommended right subcostal incision and total or near-total cystopericystectomy as a first choice of surgical technique. Nous avons étudié rétrospectivement 19 patients opérés pour une hydaditose hépatique s'étendant soit vers le diaphragme, soit vers le thorax par extension transdiaphragmatique (TD) dans une série de 444 patients ayant été opérés. Dans tous les cas de TD, le diagnostic a été confirmé par l'échographie, la tomodensitométrie ou la résonance magnétique nucléaire. Nous proposons une nouvelle classification (grades 1 à 5), basée sur le degré de TD. Avant 1984, une thoracophrénolaparotomie a été la voie d'abord préférée (9 cas) puis on a utilisé la voie souscostale droite. Seulement quatre patients ont nécessité une résection pulmonaire atypique. Chez 13 patients, on a réparé immédiatement le diaphragme et tous les kystes hydatiques hépatiques (n=24) ont été traités par une périkystectomie soit totale (16 cas) soit partielle (8 cas). Il n'y a eu aucun décès et la complication la plus grave observée a été une fistule biliaire et bilio-bronchique. Nous recommandons la périkystectomie totale ou presque totale par une incision sous-costale droite prolongée chez ces patients. Hemos realizado un estudio retrospectivo de 19 pacientes operados por enfermedad hidatídica hepática con extensión diafragmática o transdiafragmática (E-TD) al toráx, dentro de un total de 44 pacientes sometidos a cirugía por enfermedad hidatídica del hígado. En la totalidad de los casos la extensión E-TD fue confirmada por ultrasonografía, TAC o resonancia magnética. Proponemos una nueva clasificación (grados 1 a 5) basada en el grado de desarrollo de la extensión E-TD. Con anterioridad a 1984, se hizo la exposición mediante toracofrenolaparotomía (9 casos) y más tarde por incisión subcostal derecha. Sólo 4 pacientes requirieron una resección pulmonar atípica. En 13 casos el diafragma fue reparado y todos los 24 quistes hepáticos fueron tratados mediante cistopericistectomía total (16 casos) o parcial (8 casos). No se registró mortalidad operatoria y la morbilidad más seria consistió en una fístula biliar y una broncobiliar. Para el tratamiento de este tipo de pacientes nosotros recomendamos una incisión subcostal derecha y una cistopericistectomía total o casi total como la técnica quirúrgica de primera escogencia.

Research paper thumbnail of Repaso de termodinámica química 7

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA100 TM SYSTEM 1 . 1 Footnote: Not available for sale in the USA; pending 510(k) clearance. Presented in part at the XVIth meeting of the I.S.T.H. (Florence, 1997)

Thrombosis Research, 1997

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA-100TM SYSTEM

Thrombosis Research, 1997

Research paper thumbnail of Long-term Biliary Complications after Liver Surgery Leading to Liver Transplantation

World Journal of Surgery, 2001

Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life ... more Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life and may lead to secondary biliary cirrhosis with liver failure. We reviewed our experience with chronic biliary complications after surgical treatment of various diseases that at the end needed a liver transplantation. Twelve patients with previous biliary surgery developed secondary biliary cholangitis, secondary biliary cirrhosis, or both. Seven had surgery for liver hydatid disease by Echinococcus granulosus, another four had complicated biliary surgery unrelated to hydatid disease, and one had a history of a traffic accident with liver trauma and hepatectomy with chronic biliary fistula. The repeated cholangitis attacks and in two cases of hydatid disease the development of biliary-bronchial fistulas made these patients' lives miserable. All had had previous surgical procedures that made the transplantation procedure more difficult. Nevertheless, patient survival and graft actuarial survival after liver replacement were 75.0% and 69.2%, respectively, at 5 years.

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA100 TM SYSTEM 1 . 1 Footnote: Not available for sale in the USA; pending 510(k) clearance. Presented in part at the XVIth meeting of the I.S.T.H. (Florence, 1997)

Thrombosis Research, 1997

Research paper thumbnail of Advanced donor age increases the risk of severe recurrent hepatitis C after liver transplantation

Transplant International, 2005

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA-100TM SYSTEM

Thrombosis Research, 1997

Research paper thumbnail of Long-term Biliary Complications after Liver Surgery Leading to Liver Transplantation

World Journal of Surgery, 2001

Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life ... more Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life and may lead to secondary biliary cirrhosis with liver failure. We reviewed our experience with chronic biliary complications after surgical treatment of various diseases that at the end needed a liver transplantation. Twelve patients with previous biliary surgery developed secondary biliary cholangitis, secondary biliary cirrhosis, or both. Seven had surgery for liver hydatid disease by Echinococcus granulosus, another four had complicated biliary surgery unrelated to hydatid disease, and one had a history of a traffic accident with liver trauma and hepatectomy with chronic biliary fistula. The repeated cholangitis attacks and in two cases of hydatid disease the development of biliary-bronchial fistulas made these patients' lives miserable. All had had previous surgical procedures that made the transplantation procedure more difficult. Nevertheless, patient survival and graft actuarial survival after liver replacement were 75.0% and 69.2%, respectively, at 5 years.

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA100 TM SYSTEM 1 . 1 Footnote: Not available for sale in the USA; pending 510(k) clearance. Presented in part at the XVIth meeting of the I.S.T.H. (Florence, 1997)

Thrombosis Research, 1997

Research paper thumbnail of Advanced donor age increases the risk of severe recurrent hepatitis C after liver transplantation

Transplant International, 2005

Research paper thumbnail of COMPARISON OF FOUR COMMERCIAL CITRATE BLOOD COLLECTION SYSTEMS FOR PLATELET FUNCTION ANALYSIS BY THE PFA-100TM SYSTEM

Thrombosis Research, 1997

Research paper thumbnail of Long-term Biliary Complications after Liver Surgery Leading to Liver Transplantation

World Journal of Surgery, 2001

Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life ... more Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life and may lead to secondary biliary cirrhosis with liver failure. We reviewed our experience with chronic biliary complications after surgical treatment of various diseases that at the end needed a liver transplantation. Twelve patients with previous biliary surgery developed secondary biliary cholangitis, secondary biliary cirrhosis, or both. Seven had surgery for liver hydatid disease by Echinococcus granulosus, another four had complicated biliary surgery unrelated to hydatid disease, and one had a history of a traffic accident with liver trauma and hepatectomy with chronic biliary fistula. The repeated cholangitis attacks and in two cases of hydatid disease the development of biliary-bronchial fistulas made these patients' lives miserable. All had had previous surgical procedures that made the transplantation procedure more difficult. Nevertheless, patient survival and graft actuarial survival after liver replacement were 75.0% and 69.2%, respectively, at 5 years.

Research paper thumbnail of Cardiovascular risk factors in 116 patients 5 years or more after liver transplantation

Transplant International, 2002

Abstract We assessed the cardiovascular risk factors (CVRFs) in 116 stable liver transplant patie... more Abstract We assessed the cardiovascular risk factors (CVRFs) in 116 stable liver transplant patients surviving for 5 years of more (median: 102 months). The prevalence of smokers was 29.3%, hypertension 49.1%, obesity 22.4%, hypercholesterolemia 34.5%, hypertriglyceridemia 11.2%, and hyperhomocysteinemia 57.8%. Diabetes was found in 21.5% of the patients, being more frequent in patients with hepatitis-C-virus infection (31.8% vs 15.3%; P= 0.03). Patients on cyclosporine therapy had a higher prevalence of hypertension, hypercholesterolemia and hyperthomocysteinemia than those treated with tacrolimus. Multivariate analysis showed only an association between cyclosporine therapy and cholesterol concentrations (odds ratio: 1.02; 95% confidence interval (CI): 1.00–1.03; P= 0.01). The prevalence of hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia was lower at the time of the study than at 1 and 3 years after transplantation (P<0.05), probably related to steroid withdrawal. Comparing 87 patients CVRFs with the general Spanish population, we found that the age-gender standardized prevalence ratio was not different: smoking 1.46 (95% CI: 0.88–1.76), obesity 1.16 (95% CI: 0.60–1.44), hypertension 1.55 (95% CI: 0.98–1.81), and hypercholesterolemia 0.64 (95% CI: 0.35–1.90). We conclude that the prevalence of CVRFs in liver transplant patients after 5 years or more is lower that found in the first years after the transplantation, and no different from that found within the Spanish population.

Research paper thumbnail of Surgical resection of biliary tract malignancies after intervention al radiology treatment

Journal of Surgical Oncology, 1993

Skip to Main Content. ...

Research paper thumbnail of Choledochocholedochostomy Conversion to Hepaticojejunostomy due to Biliary Obstruction in Liver Transplantation

World Journal of Surgery, 2001

Choledochocholedochostomy with tutor (CC-T) or without (CC) is the technique of choice for biliar... more Choledochocholedochostomy with tutor (CC-T) or without (CC) is the technique of choice for biliary reconstruction in orthotopic liver transplantation (OLT), however, its rate of complications is high and does not decrease significantly over the years. Biliary obstruction is the most frequent complication and surgical treatment frequently involves conversion to hepaticojejunostomy (H-J). Out of 412 patients (448 OLTs) analyzed retrospectively, 74 (18%) presented biliary complications and 25 (6%) required conversion to H-J because of biliary obstruction, generally due to anastomotic stenosis (17 patients, 68%). Sixteen out of the 25 presented after the first 3 months, and in two patients, stenosis was secondary to arterial thrombosis. Anastomotic stenosis was more frequent in the CC group than in the CC-T group (9.9% versus 2.6%, p

Research paper thumbnail of Steroid withdrawal is safe and beneficial in stable cyclosporine-treated liver transplant patients

Journal of Hepatology, 1998

In the immunosuppression of orthotopic liver transplant recipients, steroids are used despite the... more In the immunosuppression of orthotopic liver transplant recipients, steroids are used despite their unspecific action and long-term side effects. Few studies have been carried out on steroid withdrawal and many aspects remain to be elucidated. A prospective study was performed to analyse the effect of steroid withdrawal on 86 patients with stable graft function, more than 1 year after orthotopic liver transplant. Thirty patients had chronic hepatitis in the graft. Seventy-two continued with cyclosporine (CsA) and 14 with CsA-azathioprine (AZA) therapy. The follow-up was 23.2 +/- 8.1 months (range 12-52 months). A paired t-test was used for statistical analysis. No acute or chronic rejection occurred, and steroids were not reinstituted. There were no changes in serum transaminase levels, but bilirubin levels decreased (p &amp;amp;lt; 0.01). At the end of the follow-up, we found improvements in blood pressure in hypertensive patients (systolic 156.1 +/- 8.4 mmHg vs. 139.4 +/- 8.7 mmHg, p &amp;amp;lt; 0.001); body weight (72 +/- 13.5 kg vs. 70.8 +/- 13 kg, p &amp;amp;lt; 0.05); serum cholesterol (211.3 +/- 42 mg/dl vs. 191.6 +/- 43.5 mg/dl, p &amp;amp;lt; 0.001) and bone mineral density in lumbar spine (0.823 +/- 0.13 g/cm2 vs. 0.893 +/- 0.135 g/cm2, p &amp;amp;lt; 0.001). Four of ten diabetic patients were no longer insulin-dependent and insulin requirements decreased in the remaining six. No significant biochemical changes were found in patients with hepatitis in the graft, and we found an improvement in inflammatory activity in the nine biopsied patients. Steroid withdrawal with CsA monotherapy is feasible, safe and beneficial in patients who have stable liver graft function 1 year after orthotopic liver transplant. We consider that AZA therapy is not necessary unless drastic reduction of CsA levels is required because of renal dysfunction.

Research paper thumbnail of Diaphragmatic or transdiaphragmatic thoracic involvement in hepatic hydatid disease: Surgical trends and classification

World Journal of Surgery, 1995

We performed a retrospective study of 19 patients who had been operated on for hepatic hydatid di... more We performed a retrospective study of 19 patients who had been operated on for hepatic hydatid disease with diaphragmatic or transdiaphragmatic (D-TD) thoracic involvement chosen from a total of 444 patients who underwent operations for hepatic hydatid disease. In all cases D-TD involvement was confirmed by ultrasonography, CT, or MRI scan. We propose a new classification (grades 1–5) based on the degree of development of D-TD involvement. Before 1984 exposure was obtained by thoracophrenolaparotomy (nine cases) and later by right subcostal incision. Only four patients required atypical pulmonary resection. In 13 cases the diaphragm was repaired, and all 24 hepatic cysts were treated with total (16 cases) or partial (8 cases) cystopericystectomy. There was no operative mortality, and the most serious morbidity consisted of a biliary fistula and a biliobronchial fistula. For treatment of these patients we recommended right subcostal incision and total or near-total cystopericystectomy as a first choice of surgical technique. Nous avons étudié rétrospectivement 19 patients opérés pour une hydaditose hépatique s'étendant soit vers le diaphragme, soit vers le thorax par extension transdiaphragmatique (TD) dans une série de 444 patients ayant été opérés. Dans tous les cas de TD, le diagnostic a été confirmé par l'échographie, la tomodensitométrie ou la résonance magnétique nucléaire. Nous proposons une nouvelle classification (grades 1 à 5), basée sur le degré de TD. Avant 1984, une thoracophrénolaparotomie a été la voie d'abord préférée (9 cas) puis on a utilisé la voie souscostale droite. Seulement quatre patients ont nécessité une résection pulmonaire atypique. Chez 13 patients, on a réparé immédiatement le diaphragme et tous les kystes hydatiques hépatiques (n=24) ont été traités par une périkystectomie soit totale (16 cas) soit partielle (8 cas). Il n'y a eu aucun décès et la complication la plus grave observée a été une fistule biliaire et bilio-bronchique. Nous recommandons la périkystectomie totale ou presque totale par une incision sous-costale droite prolongée chez ces patients. Hemos realizado un estudio retrospectivo de 19 pacientes operados por enfermedad hidatídica hepática con extensión diafragmática o transdiafragmática (E-TD) al toráx, dentro de un total de 44 pacientes sometidos a cirugía por enfermedad hidatídica del hígado. En la totalidad de los casos la extensión E-TD fue confirmada por ultrasonografía, TAC o resonancia magnética. Proponemos una nueva clasificación (grados 1 a 5) basada en el grado de desarrollo de la extensión E-TD. Con anterioridad a 1984, se hizo la exposición mediante toracofrenolaparotomía (9 casos) y más tarde por incisión subcostal derecha. Sólo 4 pacientes requirieron una resección pulmonar atípica. En 13 casos el diafragma fue reparado y todos los 24 quistes hepáticos fueron tratados mediante cistopericistectomía total (16 casos) o parcial (8 casos). No se registró mortalidad operatoria y la morbilidad más seria consistió en una fístula biliar y una broncobiliar. Para el tratamiento de este tipo de pacientes nosotros recomendamos una incisión subcostal derecha y una cistopericistectomía total o casi total como la técnica quirúrgica de primera escogencia.

Research paper thumbnail of Repaso de termodinámica química 7