Bueno, A. (Álvaro)
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- (Mis)Understandings of defence diplomacy as public diplomacy: Insights from three Spanish elites(Servicio de Publicaciones de la Universidad de Navarra, 2023) Bueno, A. (Álvaro)Defence diplomacy and public diplomacy are two diplomatic practices often treated in the literature as two disconnected realms. While the former focuses on the peaceful and cooperative use of armed forces, the latter emphasizes on the advancement of strategic communication in the international policy of actors. However, it is possible to bridge the differences between the two using the concept of soft power. By doing so, defence public diplomacy can be understood as a set of practices developed by states seeking to influence and attract third states while employing military force within these parameters. This paper contributes firstly to the conceptual debate bridging both types of diplomacies. Secondly, it selects a case study, Spain, to examine the perceptions of three different Spanish elites involved in the formulation and implementation of defence public policy: politicians, the military and defence industry managers. This paper adopts a qualitative methodology, including in-depth interviews, focus groups with experts, and manual content analysis of primary documentary sources. The results show that these elites agree on the importance of defence diplomacy for the achievement of state goals but continue to understand it fundamentally from a classical diplomatic prism. They also discuss the inclusion of new concepts, such as deterrence, as part of a defence public diplomacy.
- Análisis de la morbilidad postoperatoria en pacientes con adenocarcinoma gástrico tratados según protocolo de quimiorradioterapia preoperatoria y cirugía(Elsevier, 2009-12) Valenti, V. (Víctor); Blasco-Blanco, M. (Manuel); Bueno, A. (Álvaro); Martinez-Regueira, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Zozaya-Larequi, G. (Gabriel); Hernandez-Lizoain, J.L. (Jose Luis); Gil, A. (Aurora); Marti-Cruchaga, P. (Pablo); Pedano, N. (Nicolás); Beorlegui, C. (Carmen)Introducción El impacto del tratamiento neoadyuvante sobre las complicaciones postoperatorias en el cáncer de estómago es motivo de controversia. El objetivo de este trabajo es analizar la morbilidad y la mortalidad postoperatoria en un grupo de pacientes a los que se les había aplicado un protocolo de quimiorradioterapia preoperatoria, así como identificar posibles factores de riesgo que se asocian al desarrollo de complicaciones. Material y métodos Entre junio de 2005 y junio de 2008, pacientes diagnosticados de adenocarcinoma gástrico localmente avanzado se intervinieron en nuestro Centro tras haber seguido un protocolo de quimiorradioterapia preoperatoria. Se recogieron prospectivamente los datos sobre morbilidad y mortalidad postoperatoria y se analizaron las variables dependientes relacionadas con los pacientes, con el tipo de intervención y las características tumorales. Resultados Se evaluaron 40 pacientes. La morbilidad y la mortalidad global fue del 32,5% (13 pacientes) y del 2,5% (un paciente), respectivamente. Las complicaciones más frecuentes fueron la neumonía en el 12,9% y la sepsis por catéter en el 9,7% de los pacientes. Los factores de riesgo para el desarrollo de complicaciones fueron el índice de masa corporal (>25 kg/m2) y la inclusión en la resección del páncreas o del bazo. Conclusiones El tratamiento preoperatorio con quimiorradioterapia en pacientes con cáncer de estómago localmente avanzado no incrementa la incidencia de complicaciones postoperatorias. La condición preoperatoria del paciente (índice de masa corporal) y la extensión de la cirugía del bazo y del páncreas son factores pronósticos de complicaciones postoperatorias precoces. Abstract Introduction The impact of neoadjuvant treatment on the postoperative complications in stomach cancer is a subject of controversy. The aim of this study is to analyse the post-surgical morbidity and mortality in a group of patients who were treated using a chemoradiotherapy protocol before surgery, as well as to identify the possible risk factors that may be associated with the development of complications. Material and methods Patients diagnosed with locally advanced gastric adenocarcinoma between June 2005 and June 2008 were operated on in our Centre after having followed a preoperative chemoradiotherapy protocol. Data on postoperative morbidity and mortality were collected retrospectively and the dependent variables associated with the patients, the type of intervention and the tumour characteristics were analysed. Results A total of 40 patients were evaluated. The overall morbidity and mortality was 32.5% (13 patients) and 2.5% (1 patient), respectively. The most frequent complications were pneumonia in 12.9% and sepsis due to the catheter in 9.7% of the patients. The risk factors for the development of complications were the body mass index (BMI 25 kg/m2) and the inclusion of the pancreas and/or spleen in the resection. Conclusions Preoperative treatment with chemoradiotherapy in patients with locally advanced stomach cancer does not increase the incidence of post-surgical complication. The preoperative condition of the patient (BMI) and extending the surgery to the spleen and pancreas are prognostic factors of early postoperative complications.
- Peutz-Jeghers syndrome and duodeno-jejunal adenocarcinoma-therapeutic implications(Arán Ediciones, 2009) Blasco-Blanco, M. (Manuel); Bueno, A. (Álvaro); Angós, R. (Ramón); Martinez-Regueira, F. (Fernando); Baixauli-Fons, J. (Jorge); Álvarez-Cienfuegos, J. (Javier); Zozaya-Larequi, G. (Gabriel); Hernandez-Lizoain, J.L. (Jose Luis); Idoate, M.A. (Miguel Ángel)The Peutz-Jeghers syndrome (PJS) is an autosomal dominant hamartomatous poliposis describred in 1921. Hemminki in 1997 described the presence of LKB-1 mutation tumor-suppressor gen.The patients with PJS develop a higher cumulative incidence of gastrointestinal, pancreas and extraintestinal tumors, being occasion of a renew interest on hamartomatous polyposis syndromes regarding the clinical care, cancer surveillance treatment and long term follow-up.We report the case of a 38 years old male, diagnosed of PJS who developed a multiple adenocarcinoma in duodenum and yeyunum. Surgically treated and with a long-term free disease survival of 11 years represents the sixth case reported in the spanish literature of PJS associated with a gastrointestinal tumor.A critical review, molecular alterations and the established criteria of tumor screening and surveillance are reviewed.
- The celiac axis compression syndrome (CACS): critical review in the laparoscopic era(The Spanish Society of Digestive Pathology, 2010) Valenti, V. (Víctor); Rotellar, F. (Fernando); Blasco-Blanco, M. (Manuel); Bueno, A. (Álvaro); Álvarez-Cienfuegos, J. (Javier); Vivas, I. (Isabel); Pedano, N. (Nicolás)The celiac axis compression syndrome (CACS) due to median arcuate ligament (MAL) was first described by Harjola in 1963; originating postpandrial abdominal pain, weight loss, epigastric bruit and celiac axis stenosis > 75% in angiographic studies. This clinical condition has been the origin of controversies about its pathogenesis, diagnosis and its long term clinical results. Advances in diagnostic imaging as 64 multidetector–row CT (MDCT), 3-D reconstruction, magnetic resonance (MR) and color duplex ultrasonography, provide better understanding of the syndrome and allow to identify the best candidates for surgical division of MAL fibers. Since the introduction of laparoscopic approach, and also endovascular procedures, in 2000, a new perspective has established in this challenging syndrome. With the occasion of our own experience, a critical review of the syndrome is presented.
- Estudio de casos y controles entre anastomosis intra y extracorpórea en pacientes intervenidos de hemicolectomía derecha laparoscópica(Elsevier España, 2011) Idoate, C.P. (C. P.); Bueno, A. (Álvaro); Fons, J.B. (J. B.); Hernandez-Lizoain, J.L. (Jose Luis); Bellver, M. (M.); Pedano, N. (Nicolás); Chaves, J.A. (J. A.)Introduction: There is still insufficient scientific evidence on which is the best technique to perform the anastomosis -intracorporeal (IC) or extracorporeal (EC)- in right laparoscopic hemicolectomy. The objective of the present study is to determine whether there are differences to compare in both techniques. Material and methods: A study was performed on a prospective patient series subjected to right laparoscopic hemicolectomy in our Hospital. The preoperative and the postoperative variables associated with complications recorded depending on the type of anastomosis. Results: A total of 60 patients were intervened form June 2004 to June 2010 (35 IC; 25 EC). There were no significant differences between both groups as regards baseline preoperative characteristics or associated comorbidities. The median operation time was 212 minutes (142-305 min), with no significant difference between both techniques. The number of lymph nodes removed was higher in the IC group (21 versus 14; p = 0.03). The beginning of oral tolerance and the first bowel movement were significantly earlier in the IC group. The complications rate was similar for both groups (14% IC; 16% EC; p = 0.89). Three patients in the IC group had anastomosis dehiscence. The mortality rate was 2.8% (one patient in each group). Conclusion: Intracorporeal versus extracorporeal anastomosis in right laparoscopic hemicolectomy can obtain a higher number of resected lymph nodes and an earlier oral tolerance and intestinal transit.
- Portal Revascularization in the Setting of Cavernous Transformation Through a Paracholedocal Vein: A Case Report(Elsevier, 2010) Valenti, V. (Víctor); Rotellar, F. (Fernando); Bueno, A. (Álvaro); Pardo, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Zozaya-Larequi, G. (Gabriel); Marti-Cruchaga, P. (Pablo)Diffuse thrombosis of the entire portal system (PVT) and cavernomatous transformation of the portal vein (CTPV) represents a demanding challenge in liver transplantation. We present the case of a patient with nodular regenerative hyperplasia and recurrent episodes of type B hepatic encephalopathy concomitant with PVT as well as CTPV, successfully treated with orthotopic liver transplantation. The portal inflow to the graft was carried out through the confluence of 2 thin paracholedochal varicose veins, obtaining good early graft function and recovery of the encephalopatic episodes. This alternative should be kept in mind as an option to assure hepatopetal splanchnic flow in those cases of diffuse thrombosis and cavernomatous transformation of portal vein. CI - Copyright (c) 2010 Elsevier Inc. All rights reserved.
- Intraductal papillary mucinous neoplasms (IPMN) of the pancreas: clinico-pathologic results(The Spanish Society of Digestive Pathology, 2010) Valenti, V. (Víctor); Lozano, M.D. (María Dolores); Rotellar, F. (Fernando); Bueno, A. (Álvaro); Pardo, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Zozaya-Larequi, G. (Gabriel); Marti-Cruchaga, P. (Pablo); Pedano, N. (Nicolás); Sola, J.J. (Jesús Javier)Background: intraductal papillary mucinous neoplasm (IPMN) shows a series of lesions which evolve from benign lesions –adenoma– to invasive carcinoma. Aim: to analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference. Material and methods: a retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recommendation. Demographic, diagnostic tools, surgical report, pathologic database and actuarial survival were analyzed with a follow-up from one and a half month through nine years. Results: 6 patients underwent pancreaticoduodenectomies, 4 total pancreatectomies, 2 body or central pancreatectomies, 2 partial pancreatectomies (enucleation) and 1 distal pancreatectomy. A morbidity of 46 and 0% hospital mortality were assessed, with a median length hospital stay of 10 days. In five cases, the IPMN was combined type (both main and branch pancreatic ducts involved) in four main duct-type and branch duct-type in the another six as well. Several atypia (IPMN carcinoma in situ) was observed in 2 patients and invasive carcinoma with negative lymph nodes was identified in 3 patients. A patient without invasive carcinoma died at 66 months of follow-up for pancreas adenocarcinoma. The actuarial survival up to recurrence or death was 105,133 months with a range of follow-up from 1 month and a half until 9 years. Conclusions: IPMN main duct or mixed type warrants complete resection due to its incidence of invasive carcinoma or precursor lesions of malignancy as well. Due to its multifocal pattern, patients should be followed in long-term surveillance. The management of asymptomatic IPMN type branch less than 3 cm is controversial.