Vivas, I. (Isabel)
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- 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.
- 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.
- Nuevos horizontes en el desarrollo de medios de contraste en Radiología(2013) Vivas, I. (Isabel)
- Electroporación irreversible: presente y futuro en el tratamiento del carcinoma hepatocelular(2022) Cano, D. (David); Vivas, I. (Isabel); Lasarte, J.J. (Juan José)Currently, among the possible treatments for hepatocel-lular carcinoma there is group of minimally invasive abla-tion techniques with wide clinical acceptance due to their greater efficacy and safety in comparison to traditional therapies, low cost, and no need of being admitted to hospi-tal (outpatient treatment program). Irreversible electroporation is a non-thermal abla tion technique in which electrical fields are used to create nan-opores in the cell membrane that induce tumor cell death.Irreversible electroporation has shown promising results in numerous clinical trials; however, its control on long-term tumor growth and recurrence is inferior in comparison to that of radiofrequency. Combining irreversible electropora-tion with immunological agents may increase its efficacy in the treatment of focal lesions and metastases. In this work, we present an update on IRE including procedure, mecha-nism of action, application as a treatment for HCC, and the improvements that have been made in the past few years.
- Portal-Mesenteric Venous Thrombosis(Elsevier, 2021) Domínguez-Echávarri, P.D. (Pablo Daniel); Bilbao, J.I. (José I.); Vivas, I. (Isabel); Martinez-Cuesta, A. (Antonio)The importance of portal vein thrombosis (PVT) lies mainly in the complications of prehepatic portal hypertension, which in the chronic state causes bleeding through varices. Acute PVT is the main cause of prehepatic portal hypertension in the Western world1 and the primary cause of portal hypertension of any type in noncirrhotic patients in developed countries. PVT accounts for some 8% to 10% of all cases of portal hypertension.
- Early lung cancer detection using spiral computed tomography and positron emission tomography(American Thoracic Society, 2005) Seijo, L. (Luis); Torre, W. (Wenceslao); Campo, A. (Arantza); Serra, P. (Patricia); Lozano, M.D. (María Dolores); Bastarrika, G. (Gorka); Rodriguez-Spiteri, N. (Natalia); Domínguez-Echávarri, P.D. (Pablo Daniel); Cano, D. (David); Cosin, O. (Octavio); Richter, J.A. (José Ángel); Montes, U. (Usúa); Montuenga-Badia, L.M. (Luis M.); Garcia-Velloso, M. J. (María José); Alcaide, A.B. (Ana Belén); Vivas, I. (Isabel); Zulueta, J. (Javier); Pueyo, J. (Jesús)RATIONALE: Lung cancer screening using computed tomography (CT) is effective in detecting lung cancer in early stages. Concerns regarding false-positive rates and unnecessary invasive procedures have been raised. OBJECTIVE: To study the efficiency of a lung cancer protocol using spiral CT and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS: High-risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for noncalcified nodules of 5 mm or greater, and FDG-PET was done for nodules 10 mm or larger or smaller (> 7 mm), growing nodules. RESULTS: A total of 911 individuals completed a baseline CT study and 424 had at least one annual follow-up study. Of the former, 14% had noncalcified nodules of 5 mm or larger, and 3.6% had nodules of 10 mm or larger. Eleven non-small cell lung cancers (NSCLC) and one small cell lung cancer (SCLC) were diagnosed in the baseline study (prevalence rate, 1.32%), and two NSCLCs in the annual study (incidence rate, 0.47%). All NSCLCs (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69, 91, 90, and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%. CONCLUSION: A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions.
- T-helper cell response to woodchuck hepatitis virus antigens after therapeutic vaccination of chronically-infected animals treated with lamivudine(Elsevier, 2001) Borras-Cuesta, F. (Francisco); Condreay, L. (Lynn); Hervas-Stubbs, S. (Sandra); Vivas, I. (Isabel); Prieto, J. (Jesús); Sarobe, P. (Pablo); Cullen, J.M. (John M.); Lasarte, J.J. (Juan José)BACKGROUND/AIMS: Immunotherapy of patients chronically-infected with hepatitis B virus (HBV) may have the risk of fulminant hepatitis. This risk might be diminished if immunotherapy was carried out under conditions of low viremia. METHODS: Five woodchucks chronically-infected with woodchuck hepatitis virus (WHV), a virus closely related to HBV, were treated with lamivudine for 23 weeks. At week 10, when viremia had decreased by 3-5 logs, three woodchucks were vaccinated with woodchuck hepatitis virus surface antigen (WHsAg) plus the T-helper determinant FISEAIIHVLHSR. RESULTS: It was found that the administration of lamivudine only, had no effect on the T-helper response against WHV antigens. By contrast, vaccination induced T-helper responses against WHV antigens, shifting the cytokine profile from Th2 to Th0/Th1, but was without effect on viremia, WHsAg levels, or anti-WHs antibodies. Analysis of liver biopsies showed that lamivudine administration may have reduced hepatic inflammation. By contrast, vaccination clearly enhanced hepatic inflammation. After lamivudine withdrawal, viremia returned to high levels. CONCLUSIONS: These results suggest that therapeutic vaccination of chronically-infected woodchucks under conditions of low viremia shifts the cytokine profile against viral antigens towards Th0/Th1. This shift may prevent the efficient induction of anti-WHs antibodies.
- A proof-of-concept study of the in-vivo validation of a computational fluid dynamics model of personalized radioembolization.(2021) Antón-Remírez, R. (Raúl); Antoñana, J. (Javier); Aramburu-Montenegro, J. (Jorge); Ezponda, A. (Ana); Prieto, E. (Elena); Andonegui-Isasa, A. (Asier); Ortega, J. (Julio); Vivas, I. (Isabel); Sancho, L. (Lidia); Sangro, B. (Bruno); Lorente-Bilbao, J.I. (José Ignacio); Rodríguez-Fraile, M. (María Macarena)Radioembolization (RE) with yttrium-90 (Y-90) microspheres, a transcatheter intraarterial therapy for patients with liver cancer, can be modeled computationally. The purpose of this work was to correlate the results obtained with this methodology using in vivo data, so that this computational tool could be used for the optimization of the RE procedure. The hepatic artery three-dimensional (3D) hemodynamics and microsphere distribution during RE were modeled for six Y-90-loaded microsphere infusions in three patients with hepatocellular carcinoma using a commercially available computational fluid dynamics (CFD) software package. The model was built based on in vivo data acquired during the pretreatment stage. The results of the simulations were compared with the in vivo distribution assessed by Y-90 PET/CT. Specifically, the microsphere distribution predicted was compared with the actual Y-90 activity per liver segment with a commercially available 3D-voxel dosimetry software (PLANET Dose, DOSIsoft). The average difference between the CFD-based and the PET/CT-based activity distribution was 2.36 percentage points for Patient 1, 3.51 percentage points for Patient 2 and 2.02 percentage points for Patient 3. These results suggest that CFD simulations may help to predict Y-90-microsphere distribution after RE and could be used to optimize the RE procedure on a patient-specific basis.
- A proof-of-concept study of the in-vivo validation of a computational fluid dynamics model of personalized radioembolization(2021) Antón, R. (Raúl); Antoñana, J. (Javier); Aramburu-Montenegro, J. (Jorge); Ezponda, A. (Ana); Prieto, E. (Elena); Andonegui-Isasa, A. (Asier); Ortega, J. (Julio); Vivas, I. (Isabel); Sancho-Rodriguez, L. (Lidia); Sangro, B. (Bruno); Bilbao-Jaureguízar, J. (José Ignacio); Rodriguez-Fraile, M. (Macarena)Radioembolization (RE) with yttrium-90 (90Y) microspheres, a transcatheter intraarterial therapy for patients with liver cancer, can be modeled computationally. The purpose of this work was to correlate the results obtained with this methodology using in vivo data, so that this computational tool could be used for the optimization of the RE procedure. The hepatic artery three-dimensional (3D) hemodynamics and microsphere distribution during RE were modeled for six 90Y-loaded microsphere infusions in three patients with hepatocellular carcinoma using a commercially available computational fluid dynamics (CFD) software package. The model was built based on in vivo data acquired during the pretreatment stage. The results of the simulations were compared with the in vivo distribution assessed by 90Y PET/CT. Specifically, the microsphere distribution predicted was compared with the actual 90Y activity per liver segment with a commercially available 3D-voxel dosimetry software (PLANET Dose, DOSIsoft). The average difference between the CFD-based and the PET/CT-based activity distribution was 2.36 percentage points for Patient 1, 3.51 percentage points for Patient 2 and 2.02 percentage points for Patient 3. These results suggest that CFD simulations may help to predict 90Y-microsphere distribution after RE and could be used to optimize the RE procedure on a patient-specific basis.