Diez-Caballero, A. (Alberto)
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- ¿Es razonable el abordaje laparoscópico en patología maligna colo-rectal?(Universidad de Navarra, 1999) Baixauli-Fons, J. (Jorge); Pardo, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Diez-Caballero, A. (Alberto); Martínez-Barrera, J. (Jorge)Desde que se efectuó la primera resección de colon por vía laparoscópica en 1990, han sido publicados numerosos artículos, manifestándose diferentes opiniones, algunas de ellas francamente contrapuestas, en cuanto a validez o no de esta vía de abordaje quirúrgico, para el tratamiento del cáncer colo-rectal. El presente estudio de revisión pretende poner en claro cuál es la situación actual de la resección de colon por vía laparoscópica. Se analizan las ventajas e inconvenientes de dicho tratamiento, haciendo especial hincapié en situar la realidad actual de la incidencia de metástasis en el orificio de entrada de los trócares, así como, analizar las posibles causas. Se estudia la importancia de la experiencia del equipo quirúrgico y de la curva de aprendizaje para obtener los mejores resultados. Así como la necesidad de mantener las normas establecidas para una correcta resección de intestino grueso desde el punto de vista oncológico y la importancia de efectuar este tipo de cirugía dentro de ensayos clínicos controlados.
- Comparison Between Two Warm Ischemic Models in Experimental Liver Transplantation in Pigs(Elsevier, 2003) Rotellar, F. (Fernando); Espi, A. (A.); Martinez-Regueira, F. (Fernando); Baixauli-Fons, J. (Jorge); Pardo, F. (Fernando); Olea, J. (J.); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Diez-Caballero, A. (Alberto); Nwose, P. (P.)Experimental models of warm ischemia in liver transplantation have been employed to study the mechanisms and treatment of ischemia reperfusion injury. METHODS: We compared a control group without (group A, n = 10) versus two models of warm ischemia of liver transplants in pigs: namely, occlusion of the hepatic artery and portal vein for 30 minutes (group B, n = 23) and extraction of the liver 60 minutes after cardiac arrest (group C, n = 5). Liver function tests, coagulation studies, and liver biopsies were performed during the first 24 hours post-liver transplant. RESULTS: Clamping of the hepatic vasculature in group B produced a significant liver injury compared with the control group: elevation of the ALT and an abnormal 1-hour post-revascularization biopsy similar to that observed in the cardiac arrest group C. The transaminase levels were lower among group A animals (P <.05). But the hepatic synthetic functions as reflected in the protrombin time (PT) were not affected in group B versus group A. The alteration in PT with respect to the initial value was similar among group A and group B animals, which were significantly less than that in group C (P <.05). CONCLUSIONS: Occlusion of the hepatic artery and portal vein, a simple surgical maneuver, causes moderate damage to a liver graft but less alteration of hepatic synthetic function. Clamping of the hepatic vasculture obtains more long-term survivors after OLT than cardiac arrest.
- Effect of treatment with tranexamic acid on complement activation and ischemia reperfusion in liver transplantation in pigs(Elsevier, 1999) Martinez-Regueira, F. (Fernando); Pardo, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Sierra, A. (Alejandro); Diez-Caballero, A. (Alberto); Nwose, P. (P.)
- Laparoscopic Treatment of Median Arcuate Ligament Syndrome: Analysis of Long-Term Outcomes and Predictive Factors(Elsevier, 2018) Estévez, M.G. (Mateo G.); Valenti, V. (Víctor); Rotellar, F. (Fernando); Pardo, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Zozaya-Larequi, G. (Gabriel); Hernandez-Lizoain, J.L. (Jose Luis); Diez-Caballero, A. (Alberto); Bilbao, J.I. (José I.); Vivas, I. (Isabel); Ruiz-Canela, M. (Miguel); Marti-Cruchaga, P. (Pablo)Background: Laparoscopic arcuate ligament release has been demonstrated a valid therapeutic option for arcuate ligament syndrome. Nevertheless, long-term follow-up and predictive factors have not been described for this treatment. Methods: Clinical and surgical data and short- and long-term outcomes together with the impact of the degree of stenosis of the celiac trunk were analyzed in 13 consecutive patients who underwent laparoscopic arcuate ligament release between 2001 and 2013. Results: Thirteen patients (12 F/1 M) underwent surgery. The median age was 32 years old, and their mean body mass index was 20.7 (range 14.7-25). The 13 patients presented with intense postprandial abdominal pain. Ten cases were associated with weight loss. The median duration of symptoms was 24 months (range 2-240). Three patients presented symptoms associated with superior mesenteric artery syndrome. Median operative time was 120 min (range 90-240), and there were no conversions to open surgery. Median hospital stay was 3 days (range 2-14). Over a median follow-up of 117 months (range 45-185), nine patients had excellent results although two required endovascular procedures at 70 and 24 months after surgery. Four patients (30.7%) experienced poor outcomes. When we analyzed the impact of the degree of occlusion of the celiac trunk, we observed that in patients with severe occlusion (> 70%), better results were obtained, with complete resolution of symptoms in 71% of cases. Conclusion: Laparoscopic arcuate ligament release constitutes an excellent treatment for arcuate ligament syndrome. The degree of occlusion of the celiac trunk may be a factor predictive of long-term outcomes.
- Papel de la linfadenectomía ampliada tipo R2 en el tratamiento quirúrgico del cáncer gástrico resecable(The Spanish Society of Digestive Pathology, 1994) Martinez-Regueira, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Torramade, J. (J.); Sierra, A. (Alejandro); Diez-Caballero, A. (Alberto)The extended lymphadenectomy has been proposed as routine procedure in the surgical treatment of gastric cancer, although some controversies have been published. We present a retrospective analysis on the impact of extended lymph node dissection after total gastrectomy, in terms of post-operative course and histopathologic findings, in a group of 30 patients with R2 lymphadenectomy and in 16 patients with R1 lymphadenectomy. There were no significant differences in duration of operation, amount of blood trasfusion and length of hospital stay between the 2 groups. The only significant difference was found in the greater amount of drainage output after R2 lymphadenectomy as compared with R1. There were no mortalities in either group and morbidity rate was similar for both [43% in R1 and 40% in R2) mostly in the form of abdominal infections (18% in R1 and 16% in R2]). A significantly greater number of lymph nodes was identified after R2 gastrectomy. Fifty-three per cent of patients has positive lymph nodes, 12% of them being from the N2 echelon of nodes (including one case of early gastric cancer). Careful lymph node dissection in gastric cancer surgery allows a more precise staging of the tumor with no increase in postoperative morbidity
- Late liver function with graft obtained from donors above 65 years(Elsevier, 2002) Rotellar, F. (Fernando); Martinez-Regueira, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Diez-Caballero, A. (Alberto); Herrero, J.I. (José Ignacio); Quiroga, J. (Jorge); Pardo, J. (Javier)
- El síndrome de apneas obstructivas del sueño en la obesidad: un conspirador en la sombra(Ediciones Universidad de Navarra, 2004) Frühbeck, G. (Gema); Iriarte, J. (Jorge); Diez-Caballero, A. (Alberto); Silva, C. (Camilo); Gomez-Ambrosi, J. (Javier); Salvador, J. (Javier)The obstructive sleep apnoea syndrome (OSAS) is caused by upper airway collapse during sleep. These episodes are associated with recurrent oxyhaemoglobin desaturations and arousals which lead to disruption of the sleep pattern and cognitive deterioration. Factors such as age, male sex, menopause, tobacco and alcohol consumption and anatomic abnormalities are demonstrated risk factors for OSAS development. Obesity, specially of abdominal type, is also a very strong predictor of OSAS, increasing the risk of apnoea by ten times. OSAS prevalence may reach 80% and 50% en males and females with morbid obesity respectively. OSAS induces sympathoexcitation, insulin resistance, renin-angiotensin system activation, oxidative stress, endothelial dysfunction, hypercoagulability and reduction of fibrinolysis leading to hypertension and increased cardiovascular risk. The best diagnostic procedure is polysomnography. Obesity treatment is followed by a dramatic improvement in OSAS. Weight loss of 10% results in reductions of apnoea index by 26%. Application of a positive pressure system is a very effective treatment for OSAS which reduces the apnoea index and improves cardiovascular risk and cognitive impairment.
- Cáncer de esófago (I): Valoración epidemiológica, clínica y diagnóstica según el tipo histológico(The Spanish Society of Digestive Pathology, 1992) Zornoza, G. (Gerardo); Pardo, F. (Fernando); Álvarez-Cienfuegos, J. (Javier); Hernandez-Lizoain, J.L. (Jose Luis); Torramade, J. (J.); Diez-Caballero, A. (Alberto); Benito, C. (C.); Villa, V. (V.) deFrom 1975 to 1991, sixty-eight patients were treated with surgery for esophageal cancer at the Clinica Universitaria de Navarra. This study involves an analysis of epidemiologic and predisposing risk factors in relation with the histologic type of tumor: epidermoid carcinoma vs. adenocarcinoma. The difference in mean age of males (60,5 yrs.) as compared with that of females (48,7 yrs.) was statistically significant (p < 0,05). Likewise, the mean age of patients with epidermoid carcinoma (57,8 yrs.) was significant lower (p < 0,01) as compared with that of those with adenocarcinoma (66,3 yrs.). Smoking and alcoholism were common in the group of patients with epidermoid carcinoma, while Barrett's esophagus and hiatal hernia were frequently seen in patients with adenocarcinoma. Dysphagia was the most frequent symptom both at the start of disease (75%) and with the diagnosis established (96,7%). There was no significant difference in the symptomatology of patients with one type of tumor or the other. The efficacy of ancillary diagnostic procedures such as barium swallow, esophagoscopy, computerized tomography and biopsy were likewise assessed. The most frequent site of tumor was at the middle third, with majority of patients being at clinical stage 1-2 of disease at the time of diagnosis
- Gene expression profile of omental adipose tissue in human obesity(Federation of American Society of Experimental Biology, 2004) Catalan, V. (Victoria); Álvarez-Cienfuegos, J. (Javier); Frühbeck, G. (Gema); Diez-Caballero, A. (Alberto); Martinez-Cruz, L.A. (L. Alfonso); Garcia-Foncillas, J. (Jesús); Gomez-Ambrosi, J. (Javier); Salvador, J. (Javier); Gil, M.J. (María José); Mato, J.M. (José María)The aim of the present study was to gain insight into the pathophysiology of obesity by comparing the pattern of gene expression of omental adipose tissue of obese and lean volunteers using DNA microarrays. Omental adipose tissue biopsies were obtained by laparoscopic surgery from six male patients (44.2±6.3 yr). RNA was extracted and pooled for the obese (BMI: 37.3±2.5 kg/m2) and lean (BMI: 23.4±0.8 kg/m2) groups. From the total number of genes analyzed (1,152 well-characterized human genes), 41% were expressed at sufficient levels in human adipose tissue for detection in the microarray experiments, finding that 89 genes were upregulated while 64 were down-regulated at least twofold in the omental adipose tissue obtained from obese patients. We found a general tendency to blunt lipolysis inducer genes and a global down-regulation of genes encoding growth factors. Moreover, an up-regulation in the expression of several mitogen-activated protein kinases (MAPKs) was observed. The down-regulation of genes involved in lipolysis activation may be involved in the etiopathogenesis of obesity. In addition, down-regulation of growth factors and the up-regulation of MAPKs may indicate an attempt to restrain adipocyte proliferation and differentiation. Furthermore, obesity is accompanied by an altered expression in omental adipose tissue of genes involved not only in energy homeostasis but also in quite diverse biological functions, such as immune response. The genomic approach underlines the importance of adipose tissue beyond energy metabolism.
- Involvement of leptin in the association between percentage of body fat and cardiovascular risk factors(Elsevier, 2002) Paramo, J.A. (José Antonio); Álvarez-Cienfuegos, J. (Javier); Orbe, J. (Josune); Frühbeck, G. (Gema); Irala, J. (Jokin) de; Diez-Caballero, A. (Alberto); Gomez-Ambrosi, J. (Javier); Salvador, J. (Javier); Gil, M.J. (María José)OBJECTIVES: Recent epidemiologic studies have shown that obesity is associated with elevated blood concentrations of prothrombotic-proinflammatory factors and markers of endothelial dysfunction such as fibrinogen, C-reactive protein (CRP), von Willebrand factor (vWF), and homocysteine. We have assessed whether these markers are associated with percentage of body fat (BF), insulin sensitivity as well as with leptin concentrations. DESIGN AND METHODS: Twenty-five men aged 49.6 +/- 12.7 yr (mean +/- SD) underwent whole-body air displacement plethysmography (Bod-Pod(R)) for estimating BF. Blood analyses for leptin and several other metabolic and cardiovascular markers were carried out. RESULTS: Obese subjects had higher levels as compared to controls of BF (37.5 +/- 5.1 vs. 26.0 +/- 6.6, p < 0.01), fibrinogen (3.30 +/- 0.43 vs. 2.67 +/- 0.11, p < 0.01), vWF (136.4 +/- 50.4% vs. 81.6 +/- 12.6%, p < 0.05), and leptin (17.6 +/- 8.7 vs. 6.2 +/- 3.3, p < 0.01), lower concentrations of HDL-cholesterol (1.09 +/- 0.20 vs. 1.51 +/- 0.10, p < 0.001) and lower QUICKI (1/[log(Ins(0)) + log(Glu(0))]) (0.31 +/- 0.03 vs. 0.34 +/- 0.02, p < 0.05). No significant changes were observed in CRP (5.7 +/- 3.4 vs. 3.8 +/- 1.6, p = 0.327) and homocysteine (9.4 +/- 4.2 vs. 8.3 +/- 0.9, p = 0.749). A positive correlation was observed between BF and fibrinogen (r = 0.67, p = 0.0003). Plasma leptin concentrations were correlated with fibrinogen (r = 0.71, p = 0.0001) and CRP (r = 0.43, p = 0.044). After adjustment for BF leptin emerged as a significant predictor of fibrinogen (beta = 0.47, p = 0.023; R(2) = 0.59, p < 0.001). QUICKI was positively correlated with HDL-cholesterol (r = 0.59, p = 0.010) and negatively with fibrinogen (r = -0.53, p = 0.025), CRP (r = -0.52, p = 0.028) and vWF (r = -0.56, p = 0.013). CONCLUSIONS: Increased BF and impaired insulin sensitivity are associated with increased concentrations of cardiovascular risk factors. Leptin seems to be involved in this elevation and emerges as a predictor of circulating fibrinogen concentrations.