Biomedical subjects

Rigoberto Bernal-Maldonado

Publications and source records attributed to Rigoberto Bernal-Maldonado.

7 recordsLinked to original sources

PubMed2004

[Laparoscopic liver surgery].

INTRODUCTION: Laparoscopic surgery has been widely used for digestive tract diseases, specially for gallbladder pathology. Laparoscopic liver surgery pretends to accomplish the same objectives of open surgery but with the advantages of minimally invasive surgery. AIMS: To evaluate the indications and recent results of laparoscopic liver surgery, as well as the technique. MATERIAL AND METHODS: A review of the world literature was performed on the roll of laparoscopic surgery for hepatic diseases. The results of the authors are also reported. RESULTS: Nowadays hepatic laparoscopic surgery is reserved for anterior non-parasitic liver cysts and type I polycystic liver disease. The treatment of choice is wide deroofing. For hydatic liver disease pericystectomy or wide deroofing plus omentoplasty are also described. For benign solid liver disease, hepatic resection can be performed with the same outcome that the one observed with open surgery when the lesions are symptomatic, small, anterior or peripherally located. Laparoscopic liver surgery is recommended for the treatment of malignant hepatic lesions only in very specific cases. Nonetheless there are no prospective randomized studies that show benefits of laparoscopic over open surgery. Several local ablative therapies like radiofrequency, ethanol injection, cryotherapy or laser can be also performed through the laparoscope. The results reported so far have been encouraging. Intra-arterial chemotherapy is an option for the treatment of liver malignancies via laparoscopy, considering that the arterial catheter can be placed under this approach. CONCLUSIONS: For years, the liver has been considered a challenging organ for its approach, even with open surgery. Laparoscopic liver surgery should be performed by an experienced surgeon with the adequate technology. To our knowledge there are no reported results that decisively point toward the benefits of laparoscopic surgery over open surgery for the management of liver disease. Nonetheless more experience in laparoscopic liver surgery is needed.

Clinical Trials as Topic↗

PubMedDate not supplied

Resection of liver metastases from a virilizing steroid (lipoid) cell ovarian tumor.

The authors report the case of a 34-year-old woman who presented liver metastases from a virilizing lipoid cell ovarian tumor. The patient complained of right upper quadrant abdominal pain, strong virilization and secondary amenorrhea. She developed hirsutism and irregular menses at the age of 23, and a salpingo-ooforectomy for a right ovarian lipoid cell tumor was performed. She was asymptomatic but 6 months before admission she presented abdominal pain. The computed tomography scan showed a large right-side hypodense liver lesion. Tumor and viral markers were normal. Serum testosterone was 7 ng/mL and the dehydroepiandrosterone was 2.5 ng/mL. A right trisegmentectomy was performed. Her recovery was uneventful, hormone levels returned to normal, and she has been asymptomatic after a follow-up of 6 months.

Adult↗

PubMedDate not supplied

[Epidemiologic factors and results of treatment in peripheral and peri-hilar cholangiocarcinoma].

OBJECTIVE: Cholangiocarcinoma is a rare malignant tumor that may occur anywhere along intra or extrahepatic biliary tree. Prognosis remains poor with overall 5-year survival rate of 5%. Experience in management of this lesion in Mexico is scarce. Our objective was to report on our experience at the Instituto Nacional de Cancerología in Mexico City with the management of this lesion. PATIENTS AND METHODS: A retrospective review of clinical files of patients diagnosed and treated in a period of 10 years was performed. Epidemiologic data, forms of diagnosis, results of management, and survival were analyzed. RESULTS: From June 1992 to June 2002, 36 patients were diagnosed and treated; 25 patients had perihilar tumor (Klatskin tumor) and 11 had peripheral cholangiocarcinoma. Twenty seven were females (75%) and nine males (25%). Abdominal pain was the main symptom (72%) followed by jaundice (65%) and weight lost (59%). Computed tomography was the most used imaging study (86%); surgery was main form of management (72%). No survivors were observed in patients nor receiving treatment after a follow-up of 3 years. For those resected, an 18%, 5-year survival was observed. CONCLUSIONS: This lesion was more frequent in females between fifth and seventh decades of life and no relation with ulcerative colitis or primary sclerosing cholangitis was observed in our study. Surgery is still the best form of management but prognosis remains poor.

Adult↗

PubMedDate not supplied

A retrospective analysis of patients with gallbladder cancer treated with radical resection versus cholecystectomy plus external radiotherapy.

BACKGROUND/AIMS: To compare patients with gallbladder cancer treated with radical resection and regional lymphadenectomy (RR-RL) versus simple cholecystectomy and adjuvant external radiotherapy (SC-ERT) and determine outcome. METHODOLOGY: Presentation, operative data, complications and survival were examined in 137 patients. In particular, the 45 patients treated with RR-RL or SC-ERT. RESULTS: Twenty-five had SC-ERT and 20 had a RR-RL. There were no epidemiological differences between groups. Resection of segments IV-b and V and en bloc dissection of regional lymph nodes was the most frequently used procedure (75%). The morbidity and mortality of the radical procedure were 25% and 10%. The morbidity of SC-ERT was 16%. All patients with Nevin I are alive. For lesions Nevin II and Nevin III RR-RL offered a 100% 5-year survival rate and SC-ERT had a 62% and 39% 5-year survival rate respectively. For lesions Nevin IV and V there was no difference in long-term survival. CONCLUSIONS: RR-RL is better than SC-ERT in patients with Nevin II and III lesions because it improves survival rate. SC-ERT can be recommended as an alternative treatment. For more advanced lesions further trials are needed.

Adenocarcinoma↗

PubMedDate not supplied

[Cavernous hemangioma of the liver and hepatic hemangiomatosis. Indications and results of the surgical resection].

INTRODUCTION: Cavernous hemangioma is the most frequent focal liver lesion. It affects mainly women and may cause symptoms such as abdominal pain, mass, and early satiety, or complications such as heart failure or coagulopathy. There are several options for treatment in symptomatic patients. However, it seems that surgical resection is the only curative treatment. AIM: Evaluate indications and results of liver resection in patients with cavernous hemangiomas and hepatic hemangiomatosis. PATIENTS AND METHODS: We conducted a retrospective analysis of clinical files of patients treated at the Instituto Nacional de Cancerología (INCan) and the Centro Médico ISSEMYM during a 8-year period. Epidemiological data as well as diagnostic work-up and treatment were analyzed. RESULTS: From August 1995 to May 2003, 24 patients with liver hemangiomas were resected at both institutions. Twenty three were female (95.8%) and one, male (4.1%). Indications for surgery were presence of symptoms in 20 patients (83.3%), undefined diagnosis in three (12.5%), and rapid growth in one (4.1%). Most frequent symptoms were abdominal pain in 20 (83.3%) patients, followed by abdominal mass in five (20.8%), and early gastric satiety in four (16.6%). Abdominal computed tomography (CT) scan was the most frequent imaging study used in 22 patients (91.6%), followed by ultrasound in 20 (83.3%). Size of lesion ranged from 4-30 cm (X: 8.7 cm), 16 patients were submitted to formal liver resection (66.6%), and eight to enucleation (33.3%). Four patients presented operative complications (16.6%) that included postoperative bleeding in two (8.3%), fever in one (4.1%) and abdominal haematoma in one (4.1%). There was no operative mortality. Twenty two patients were asymptomatic at time of evaluation (91%). CONCLUSIONS: This lesion affects mainly women, and presence of symptoms is the most common indication for treatment. Choice of surgical procedure to be carried out depends on location and morphology of the lesion. Liver resection or enucleation are safe forms of treatment that properly controlled symptomatology.

Adult↗

PubMedDate not supplied

Hepatocellular carcinoma in the youth. A comparative analysis with hepatocellular carcinoma in adulthood.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is a very rare disease among young individuals. Epidemiological, clinical and histopathological features of this malignancy in the youth have not been thoroughly studied. METHODOLOGY: A review of the clinical files of patients with HCC younger than 40 years of age, who were treated between May 1990 and July 2002, was performed. RESULTS: Seventeen patients were included for analysis; nine were female and eight male. The mean age at diagnosis was 24 years (range 12-39 years). Abdominal pain was the main symptom, followed by vomiting and nausea. Enlargement of the liver was observed in 11 patients (65%). In seven patients (41%), an etiological factor was not found. Five of these cases were of the fibrolamellar variant (29%). Only four patients were resected (23%) two of which belonged to the fibrolamellar type. Three patients (18%) are still alive after 64.9 months of follow-up. CONCLUSIONS: HCC is a very uncommon disease in the youth and affects similarly both genders. It is discovered at an advanced stage. Hepatitis B and C are uncommon etiological factors. The frequency of fibrolamellar carcinoma is higher in this age group. Though resection is more feasible, the overall survival rates remain low.

Adolescent↗

PubMedDate not supplied

Intraoperative US-guided large volume ethanol injection for hepatocellular carcinoma greater than 4 cm.

BACKGROUND: Percutaneous ethanol injection has been successfully used for hepatocellular carcinomas (HCC) smaller than 5 cm in size. For larger lesions large volume ethanol injection has not been well explored. AIM: Evaluate the results of intraoperative Ultrasonographic-guided large volume ethanol injection for HCC larger than 4 cm in size. PATIENTS AND METHODS: Ten patients were candidates for this treatment between June 1999 and July 2003. A retrospective review of the clinical files was performed. Absolute ethanol, average of 100 mL (range 80-120 mL) was administered intraoperatively. Follow-up evaluation included alpha-fetoprotein (AFP) and ultrasound or computed tomography. RESULTS: There were six women and four men, the median age was 62 years (range 56-80). The median lesion size was 8 cm (range 4-15 cm). Hepatitis C liver cirrhosis was the most common associated chronic liver disease (70%). A significant reduction of AFP levels after treatment was observed (Initial 966 ng/dL, post treatment levels: 42 ng/dL) US and CT scan showed tumor necrosis. Morbidity was 40%. No operative mortality was recorded. The one and four year survival rate was 60% and 20%. CONCLUSION: Intraoperative US-guided large volume ethanol injection is a safe palliative therapy for cirrhotic patients with HCC lesions greater than 5 cm in size. The impact on survival should be compared in a controlled double blind study.

Aged↗