Hydatidosis is a worldwide spread zoonoses caused mainly by the Echinococcus granulosus, where hu... more Hydatidosis is a worldwide spread zoonoses caused mainly by the Echinococcus granulosus, where humans become the intermediary host through contact with a definitive host (commonly a dog) or through intake of food or water contaminated with Echinococcus eggs. Clinically speaking it usually presents itself as a hydatid cyst often developed in the liver due to the fact that it is where it reaches first through portal circulation. In order to reach other organs like the muscle it will still need to surpass the pulmonary filter. We report a case of muscular hydatidosis relapse in a 63 years-old male patient, with a history of hydatid cyst resection in left thigh 10 years ago, presenting a new tumor in the same region with 5 years of progressive growing evolution. Soft parts ultrasound (US) shows oval lesions with ecogenic content and a daughter vesicules on the inside. Abdominal ultrasound and CT scan show two rounded hypodense images, one in segment IV and another one in segment VII, wh...
Background: Liver resection is effective treatment for primary and secondary liver tumors, though... more Background: Liver resection is effective treatment for primary and secondary liver tumors, though clinical applicability is limited by remnant liver mass and quality. Aims: Perform major hepatic resections in pigs to define changes associated with sufficient and insufficient remnants and improve liver-specific outcomes through continuous somatostatin infusion. Methods: Three experimental groups were performed: 75% hepatectomy (75H), 90% hepatectomy (90H), and 90% hepatectomy with somatostatin (90H+SST). In each group, animals were followed for 24 hours (N=6) and 5 days (N=6). Results: After hepatectomy, portal venous pressure gradient was higher in 90H versus 75H and 90H+SST (8[3-13] mmHg vs. 4[2-6] mmHg and 4[2-6] mmHg, respectively, P <0.001). After 24 hours, changes were observed in 90H associated with stellate cell activation and collapse of sinusoidal lumen (area 23.5±3.6% 90H vs. 31.1±3.5% 75H, P <0.001, and 30.9±4.3% 90H+SST, P=0.008). Collagen chain type 1 alpha 1 mRNA expression was higher, extracellular matrix width less, and percentage of collagen-staining areas greater at 24 hours in 90H versus 75H and 90H+SST.After 5 days, remnant liver mass was higher in 75H and 90H+SST versus 90H (469±33 g and 463±79 g vs. 313±107, respectively, P=0.003), and Ki-67 immunostaining was higher in 90H+SST versus 75H and 90H (10±7 high-power field-1 vs. 2±2 high-power field-1 and 5±6 high-power field-1, respectively, P<0.001). More TUNEL-staining cells were observed in 90H versus 75H and 90H+SST at 5 days. Conclusions: Perioperative somatostatin modified portal pressure, injury, apoptosis, and hepatic stellate cell activation, stemming early changes related to hepatic fibrogenesis seen in liver remnants not receiving treatment. Funding: Research was supported by FIS Grant 15/01092 from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovacion, Spain. Amelia J. Hessheimer was supported by the “Ajut Josep Font” from the Hospital Clinic Barcelona. Lilia Martinez de la Maza was supported by the Fundacio Catalana de Trasplantament. Declaration of Interest: Amelia J. Hessheimer and Constantino Fondevila have received research funding and consultancy fees from Guanguong Shunde Innovative Design Institute, Guangdong, China. The remainder of the authors have nothing to declare. Ethical Approval: The University of Barcelona Animal Experimentation Unit is authorized by the Catalan Department of Agriculture, Husbandry, and Fisheries (authorization number B9900020), registered in the General Registry of Livestock Facilities (ES080190036536), and accredited by the International Standards Organization (ISO 9001:2015). Animals were cared for according to the guidelines of the Catalan Department of the Environment Commission on Animal Experimentation and University of Barcelona Committee on Ethics in Animal Experimentation, which approved the study protocol.
Primary retroperitoneal mucinous cystic tumors are extremely rare neoplasms that usually occur in... more Primary retroperitoneal mucinous cystic tumors are extremely rare neoplasms that usually occur in women. Their histogenesis has not been clarified. Their low incidence has meant that it difficult to define therapeutic strategies or prognosis, or to record survival data. We describe a 35 year-old female with a retroperitoneal mucinous cystadenoma presenting a mural nodule with foci of sarcomatoid carcinoma. The entire tumor was surgically removed. After surgery, the patient received six cycles of carboplatin and paclitaxel. After 30 months of follow up she has shown no signs of recurrence. We review the etiology, diagnosis and therapeutic options in these extremely rare tumors.
Figura 1 – TAC: lesión en segmento VII (flecha). Las lesiones sólidas hepáticas de nueva aparició... more Figura 1 – TAC: lesión en segmento VII (flecha). Las lesiones sólidas hepáticas de nueva aparición, en los pacientes oncológicos, nos obliga descartar como primera posibilidad las metástasis hepáticas de su neoplasia primaria. En un pequeño nú mero de pacientes pueden ser otros tumores muy infrecuentes y hacer muy complejo llegar a un diagnóstico diferencial preoperatorio correcto. Presentamos el caso de una paciente con una hiperplasia nodular regenerativa (HNR) hepática mú ltiple asociada a oxaliplatino. Debatimos los efectos secundarios hepáticos del oxaliplatino y el manejo clı́nico de estos pacientes. Mujer de 49 años, con antecedentes de hemicolectomı́a izquierda laparoscópica en 2010 por adenocarcinoma enteroide de colon bien diferenciado de 3 cm, pT3N0M0 con invasión perineural. Fue tratada con XELOX (oxaliplatino 130 mg dı́a 1 y Xeloda 1.000 mg/m/12 h durante 14 dı́as cada 21 dı́as) durante 6 meses. Otros antecedentes: quiste de ovario, obesidad (IMC: 36), diabetes mellitus no insulinodependiente, dislipemia y bocio multinodular. Índice de Premm: 1,2, Riesgo de cáncer hereditario no polipósico: 7%. Fenotipo negativo para inestabilidad de microsatélites (MLH1, MSH2, MSH y PMS2 positivos). A los 30 meses del postoperatorio la TAC objetiva esteatosis hepática, lesión hipervascular focal de nueva aparición de 30 20 mm entre los segmentos VI y VII, y otra en el segmento IV de 8,5 mm que presentan realce en la fase portal y, además, leve trabeculación de la grasa mesentérica compatible con paniculitis mesentérica, no existı́an signos de hipertensión portal (fig. 1). El hemograma, la bioquı́mica hepática y los marcadores tumorales (CEA y CA19-9) eran normales. Se realiza PET que demuestra que las lesiones hepáticas no captan, la zona de paniculitis muestra un SUV de 3,2. Ante los hallazgos no concluyentes se decide realizar laparotomı́a exploradora. Se visualiza la lesión del segmento VII y se observan 2 lesiones de 2-3 mm en los segmentos II y III. Se realiza ecografı́a intraoperatoria donde se detectan otras 5 lesiones intraparenquimatosas de 3-8 mm, una de ellas la observada en el segmento IV en la TAC. El
Complications of dropped gallstones after laparoscopic cholecystectomy are infrequent but retrope... more Complications of dropped gallstones after laparoscopic cholecystectomy are infrequent but retroperitoneal abscess is extremely rare. We present a new case, discuss causes, diagnostic methods, preventive measures and therapeutical options.
Background: Frank intrabiliary rupture (FIR) is a severe complication that occurs in around 30% o... more Background: Frank intrabiliary rupture (FIR) is a severe complication that occurs in around 30% of patients with liver hydatidosis. When FIR is present, the contents of the cyst may pass into the common bile duct and cause a variety of complications. If the FIR is located in the hilar confluence, surgical repair is a challenge. Currently there are no data regarding its optimum treatment. Material and Methods: Between May 2007 and December 2012, we treated 59 patients with liver hydatidosis. Four patients, all women, with a mean age of 51.7 years, had hydatid cysts located between segments IVb and V and FIR affecting the hilar plate. In 3 cases, the initial clinical condition was obstructive jaundice. The fourth patient presented recurrence after having undergone two operations as a child. Results: In each patient a major hepatectomy was performed with hilar plate reconstruction (3 left and 1 right). Morbidity included mild biliary fistula (1 patient) and abdominal collection resolve...
Until Atlanta Classification (AC) made in 1992, there was not any classification of acute pancrea... more Until Atlanta Classification (AC) made in 1992, there was not any classification of acute pancreatitis (AP). Last twenty years AC let us compare results and papers. But the increasing understanding of the pathophysiology of AP, improvements in diagnostic methods and the development of minimally invasive tools for radiological, endoscopic and surgical management of local complications, several authors have called for the AC to be reviewed. Last months, two new classifications of AP have been published. We made a historical review of AC, the two new classifications and a comparison between them.
Background: Bioprostheses represent a significant advance in the abdominal wall reconstruction si... more Background: Bioprostheses represent a significant advance in the abdominal wall reconstruction since they become degraded until their complete elimination in the recipient organism. This study examines remodeling in the host of three noncrosslinked porcine dermal collagen biomeshes: Strattice™ (St; LifeCell Corp.), XCM Biologic® Tissue Matrix (XCM; Synthes CMF) and Protexa® (Pr; Deco Med S.R.L.). Methods: Partial ventral hernia defects created in New Zealand White rabbits were repaired using the biomeshes that were placed in an inlay, preperitoneal position. At 14 and 90 days after implantation, explants were assessed in terms of their host tissue incorporation by morphological studies, collagen gene/protein expression (quantitative real-time PCR/immunofluorescence), macrophage response (immunohistochemistry) and biomechanical strength. Results: There were no cases of mortality or infection. Among our macroscopic findings, the mesh detachment detected in one third of the Pr implants...
Hydatidosis is a worldwide spread zoonoses caused mainly by the Echinococcus granulosus, where hu... more Hydatidosis is a worldwide spread zoonoses caused mainly by the Echinococcus granulosus, where humans become the intermediary host through contact with a definitive host (commonly a dog) or through intake of food or water contaminated with Echinococcus eggs. Clinically speaking it usually presents itself as a hydatid cyst often developed in the liver due to the fact that it is where it reaches first through portal circulation. In order to reach other organs like the muscle it will still need to surpass the pulmonary filter. We report a case of muscular hydatidosis relapse in a 63 years-old male patient, with a history of hydatid cyst resection in left thigh 10 years ago, presenting a new tumor in the same region with 5 years of progressive growing evolution. Soft parts ultrasound (US) shows oval lesions with ecogenic content and a daughter vesicules on the inside. Abdominal ultrasound and CT scan show two rounded hypodense images, one in segment IV and another one in segment VII, wh...
Background: Liver resection is effective treatment for primary and secondary liver tumors, though... more Background: Liver resection is effective treatment for primary and secondary liver tumors, though clinical applicability is limited by remnant liver mass and quality. Aims: Perform major hepatic resections in pigs to define changes associated with sufficient and insufficient remnants and improve liver-specific outcomes through continuous somatostatin infusion. Methods: Three experimental groups were performed: 75% hepatectomy (75H), 90% hepatectomy (90H), and 90% hepatectomy with somatostatin (90H+SST). In each group, animals were followed for 24 hours (N=6) and 5 days (N=6). Results: After hepatectomy, portal venous pressure gradient was higher in 90H versus 75H and 90H+SST (8[3-13] mmHg vs. 4[2-6] mmHg and 4[2-6] mmHg, respectively, P <0.001). After 24 hours, changes were observed in 90H associated with stellate cell activation and collapse of sinusoidal lumen (area 23.5±3.6% 90H vs. 31.1±3.5% 75H, P <0.001, and 30.9±4.3% 90H+SST, P=0.008). Collagen chain type 1 alpha 1 mRNA expression was higher, extracellular matrix width less, and percentage of collagen-staining areas greater at 24 hours in 90H versus 75H and 90H+SST.After 5 days, remnant liver mass was higher in 75H and 90H+SST versus 90H (469±33 g and 463±79 g vs. 313±107, respectively, P=0.003), and Ki-67 immunostaining was higher in 90H+SST versus 75H and 90H (10±7 high-power field-1 vs. 2±2 high-power field-1 and 5±6 high-power field-1, respectively, P<0.001). More TUNEL-staining cells were observed in 90H versus 75H and 90H+SST at 5 days. Conclusions: Perioperative somatostatin modified portal pressure, injury, apoptosis, and hepatic stellate cell activation, stemming early changes related to hepatic fibrogenesis seen in liver remnants not receiving treatment. Funding: Research was supported by FIS Grant 15/01092 from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovacion, Spain. Amelia J. Hessheimer was supported by the “Ajut Josep Font” from the Hospital Clinic Barcelona. Lilia Martinez de la Maza was supported by the Fundacio Catalana de Trasplantament. Declaration of Interest: Amelia J. Hessheimer and Constantino Fondevila have received research funding and consultancy fees from Guanguong Shunde Innovative Design Institute, Guangdong, China. The remainder of the authors have nothing to declare. Ethical Approval: The University of Barcelona Animal Experimentation Unit is authorized by the Catalan Department of Agriculture, Husbandry, and Fisheries (authorization number B9900020), registered in the General Registry of Livestock Facilities (ES080190036536), and accredited by the International Standards Organization (ISO 9001:2015). Animals were cared for according to the guidelines of the Catalan Department of the Environment Commission on Animal Experimentation and University of Barcelona Committee on Ethics in Animal Experimentation, which approved the study protocol.
Primary retroperitoneal mucinous cystic tumors are extremely rare neoplasms that usually occur in... more Primary retroperitoneal mucinous cystic tumors are extremely rare neoplasms that usually occur in women. Their histogenesis has not been clarified. Their low incidence has meant that it difficult to define therapeutic strategies or prognosis, or to record survival data. We describe a 35 year-old female with a retroperitoneal mucinous cystadenoma presenting a mural nodule with foci of sarcomatoid carcinoma. The entire tumor was surgically removed. After surgery, the patient received six cycles of carboplatin and paclitaxel. After 30 months of follow up she has shown no signs of recurrence. We review the etiology, diagnosis and therapeutic options in these extremely rare tumors.
Figura 1 – TAC: lesión en segmento VII (flecha). Las lesiones sólidas hepáticas de nueva aparició... more Figura 1 – TAC: lesión en segmento VII (flecha). Las lesiones sólidas hepáticas de nueva aparición, en los pacientes oncológicos, nos obliga descartar como primera posibilidad las metástasis hepáticas de su neoplasia primaria. En un pequeño nú mero de pacientes pueden ser otros tumores muy infrecuentes y hacer muy complejo llegar a un diagnóstico diferencial preoperatorio correcto. Presentamos el caso de una paciente con una hiperplasia nodular regenerativa (HNR) hepática mú ltiple asociada a oxaliplatino. Debatimos los efectos secundarios hepáticos del oxaliplatino y el manejo clı́nico de estos pacientes. Mujer de 49 años, con antecedentes de hemicolectomı́a izquierda laparoscópica en 2010 por adenocarcinoma enteroide de colon bien diferenciado de 3 cm, pT3N0M0 con invasión perineural. Fue tratada con XELOX (oxaliplatino 130 mg dı́a 1 y Xeloda 1.000 mg/m/12 h durante 14 dı́as cada 21 dı́as) durante 6 meses. Otros antecedentes: quiste de ovario, obesidad (IMC: 36), diabetes mellitus no insulinodependiente, dislipemia y bocio multinodular. Índice de Premm: 1,2, Riesgo de cáncer hereditario no polipósico: 7%. Fenotipo negativo para inestabilidad de microsatélites (MLH1, MSH2, MSH y PMS2 positivos). A los 30 meses del postoperatorio la TAC objetiva esteatosis hepática, lesión hipervascular focal de nueva aparición de 30 20 mm entre los segmentos VI y VII, y otra en el segmento IV de 8,5 mm que presentan realce en la fase portal y, además, leve trabeculación de la grasa mesentérica compatible con paniculitis mesentérica, no existı́an signos de hipertensión portal (fig. 1). El hemograma, la bioquı́mica hepática y los marcadores tumorales (CEA y CA19-9) eran normales. Se realiza PET que demuestra que las lesiones hepáticas no captan, la zona de paniculitis muestra un SUV de 3,2. Ante los hallazgos no concluyentes se decide realizar laparotomı́a exploradora. Se visualiza la lesión del segmento VII y se observan 2 lesiones de 2-3 mm en los segmentos II y III. Se realiza ecografı́a intraoperatoria donde se detectan otras 5 lesiones intraparenquimatosas de 3-8 mm, una de ellas la observada en el segmento IV en la TAC. El
Complications of dropped gallstones after laparoscopic cholecystectomy are infrequent but retrope... more Complications of dropped gallstones after laparoscopic cholecystectomy are infrequent but retroperitoneal abscess is extremely rare. We present a new case, discuss causes, diagnostic methods, preventive measures and therapeutical options.
Background: Frank intrabiliary rupture (FIR) is a severe complication that occurs in around 30% o... more Background: Frank intrabiliary rupture (FIR) is a severe complication that occurs in around 30% of patients with liver hydatidosis. When FIR is present, the contents of the cyst may pass into the common bile duct and cause a variety of complications. If the FIR is located in the hilar confluence, surgical repair is a challenge. Currently there are no data regarding its optimum treatment. Material and Methods: Between May 2007 and December 2012, we treated 59 patients with liver hydatidosis. Four patients, all women, with a mean age of 51.7 years, had hydatid cysts located between segments IVb and V and FIR affecting the hilar plate. In 3 cases, the initial clinical condition was obstructive jaundice. The fourth patient presented recurrence after having undergone two operations as a child. Results: In each patient a major hepatectomy was performed with hilar plate reconstruction (3 left and 1 right). Morbidity included mild biliary fistula (1 patient) and abdominal collection resolve...
Until Atlanta Classification (AC) made in 1992, there was not any classification of acute pancrea... more Until Atlanta Classification (AC) made in 1992, there was not any classification of acute pancreatitis (AP). Last twenty years AC let us compare results and papers. But the increasing understanding of the pathophysiology of AP, improvements in diagnostic methods and the development of minimally invasive tools for radiological, endoscopic and surgical management of local complications, several authors have called for the AC to be reviewed. Last months, two new classifications of AP have been published. We made a historical review of AC, the two new classifications and a comparison between them.
Background: Bioprostheses represent a significant advance in the abdominal wall reconstruction si... more Background: Bioprostheses represent a significant advance in the abdominal wall reconstruction since they become degraded until their complete elimination in the recipient organism. This study examines remodeling in the host of three noncrosslinked porcine dermal collagen biomeshes: Strattice™ (St; LifeCell Corp.), XCM Biologic® Tissue Matrix (XCM; Synthes CMF) and Protexa® (Pr; Deco Med S.R.L.). Methods: Partial ventral hernia defects created in New Zealand White rabbits were repaired using the biomeshes that were placed in an inlay, preperitoneal position. At 14 and 90 days after implantation, explants were assessed in terms of their host tissue incorporation by morphological studies, collagen gene/protein expression (quantitative real-time PCR/immunofluorescence), macrophage response (immunohistochemistry) and biomechanical strength. Results: There were no cases of mortality or infection. Among our macroscopic findings, the mesh detachment detected in one third of the Pr implants...
Uploads
Papers by Farah Adel