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1.
Rev. méd. Chile ; 148(6): 831-841, jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1139378

ABSTRACT

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease, induced by food allergens, clinically characterized by symptoms of esophageal dysfunction. Pathologically there is a predominant eosinophilic inflammation. This disease is relatively new, and its definitions have evolved over time. Its prevalence and incidence are increasing and causes clinical problems both in children and adults. Its symptoms include food impaction, dysphagia, symptoms that resemble gastroesophageal reflux, abdominal pain, and vomiting. It can also have extra-digestive symptoms such as rhinosinusitis, chronic cough, recurrent croup and hoarseness. EoE can be associated with other atopic conditions, such as asthma, eczema and food allergies. The diagnosis is made by the analysis of endoscopic biopsies (> 15 eosinophils per high power field). Proton pump inhibitors (PPIs) are currently accepted as a treatment for EoE. The clinical and pathological improvement with the use PPIs ceased to be a criterion to define Esophageal eosinophilia responsive to PPIs as a differential diagnosis, since this condition is currently considered within the EoE spectrum. There are three main treatment approaches for EoE: diet, drugs and dilation. Its diagnosis and early treatment are key to avoid or delay its complications, such as stenosis and severe esophageal dysfunction.


Subject(s)
Humans , Gastroesophageal Reflux , Eosinophilic Esophagitis/diagnosis , Eosinophilic Esophagitis/therapy , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Proton Pump Inhibitors/therapeutic use
2.
Rev. méd. Chile ; 146(10): 1215-1219, dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-978759

ABSTRACT

Abstrac: Before the advent of highly active antiretroviral therapy (HAART), patients infected with human immunodeficiency virus (HIV) were considered as having an absolute contraindication for liver transplantation (LT). Considering the increased life expectancy in HIV positive patients under HAART and the improvements in the management of graft recipients, these patients are now suitable for carrying out transplants in selected cases. We report a 26 years old HIV positive male who developed acute liver failure possibly caused by drug induced liver injury who underwent a successful liver transplantation.


Subject(s)
Humans , Male , Adult , Acquired Immunodeficiency Syndrome/drug therapy , Liver Transplantation/methods , Antiretroviral Therapy, Highly Active/adverse effects , Chemical and Drug Induced Liver Injury/surgery , Treatment Outcome , Chemical and Drug Induced Liver Injury/pathology , Immunocompetence
3.
Rev. méd. Chile ; 145(6): 799-803, June 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-902547

ABSTRACT

Liver involvement by multiple arterio-venous shunts in hereditary hemorrhagic telangiectasia can lead to severe heart failure. Total hepatectomy with liver transplantation has emerged as a therapeutic option for severe cases where other therapies have failed. We report a 51-year-old male who underwent a liver transplant for this condition, with full cardiac recovery within the first year after receiving the allograft. Nine years after transplantation, he remains with normal functional capacity and normal liver function tests.


Subject(s)
Humans , Male , Middle Aged , Telangiectasia, Hereditary Hemorrhagic/complications , Liver Transplantation/methods , Heart Failure/surgery , Anastomosis, Surgical , Treatment Outcome , Heart Failure/etiology , Liver/pathology
4.
Ann. hepatol ; 16(1): 94-106, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-838091

ABSTRACT

Abstract: The use of calcineurin inhibitors (CNI) after liver transplantation is associated with post-transplant nephrotoxicity. Conversion to mycophenolate mofetil (MMF) monotherapy improves renal function, but is related to graft rejection in some recipients. Our aim was to identify variables associated with rejection after conversion to MMF monotherapy. Conversion was attempted in 40 liver transplant recipients. Clinical variables were determined and peripheral mononuclear blood cells were immunophenotyped during a 12-month follow- up. Conversion was classified as successful (SC) if rejection did not occur during the follow-up. MMF conversion was successful with 28 patients (70%) and was associated with higher glomerular filtration rates at the end of study. It also correlated with increased time elapsed since transplantation, low baseline CNI levels (Tacrolimus ≤ 6.5 ng/mL or Cyclosporine ≤ 635 ng/mL) and lower frequency of tacrolimus use. The only clinical variable independently related to SC in multivariate analysis was low baseline CNI levels (p = 0.02, OR: 6.93, 95%, CI: 1.3-29.7). Mean baseline fluorescent intensity of FOXP3+ T cells was significantly higher among recipients with SC. In conclusion, this study suggests that baseline CNI levels can be used to identify recipients with higher probability of SC to MMF monotherapy. Clinicaltrials.gov identification: NCT01321112.


Subject(s)
Humans , Male , Middle Aged , Aged , Liver Transplantation , Tacrolimus/administration & dosage , Cyclosporine/administration & dosage , Calcineurin Inhibitors/administration & dosage , Graft Rejection/prevention & control , Graft Survival/drug effects , Immunosuppressive Agents/administration & dosage , Mycophenolic Acid/administration & dosage , Time Factors , Transcription Factors/immunology , Drug Administration Schedule , T-Lymphocytes/immunology , Chi-Square Distribution , Odds Ratio , Multivariate Analysis , Prospective Studies , Risk Factors , Liver Transplantation/adverse effects , Treatment Outcome , Tacrolimus/adverse effects , Drug Monitoring/methods , Cyclosporine/adverse effects , Drug Therapy, Combination , Calcineurin Inhibitors , Graft Rejection/immunology , Immunosuppressive Agents/adverse effects , Kidney/drug effects , Kidney/physiopathology , Mycophenolic Acid/adverse effects
5.
Rev. méd. Chile ; 144(10): 1305-1318, oct. 2016.
Article in Spanish | LILACS | ID: biblio-845445

ABSTRACT

Pancreatic cancer is a malignancy of great impact in developed countries and is having an increasing impact in Latin America. Incidence and mortality rates are similar for this cancer. This is an important reason to offer to the patients the best treatments available. During the Latin American Symposium of Gastroenterology Oncology (SLAGO) held in Viña del Mar, Chile, in April 2015, a multidisciplinary group of specialists in the field met to discuss about this disease. The main conclusions of this meeting, where practitioners from most of Latin American countries participated, are listed in this consensus that seek to serve as a guide for better decision making for patients with pancreatic cancer in Latin America.


Subject(s)
Humans , Pancreatic Neoplasms/therapy , Adenocarcinoma/therapy , Practice Guidelines as Topic , Disease Management , Consensus Development Conferences as Topic , Deoxycytidine/analogs & derivatives , Deoxycytidine/therapeutic use , Chemoradiotherapy , Latin America , Antimetabolites, Antineoplastic/therapeutic use
7.
Rev. méd. Chile ; 142(10): 1229-1237, oct. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-731653

ABSTRACT

Background: Preservation solutions are critical for organ transplantation. In liver transplant (LT), the solution developed by the University Of Wisconsin (UW) is the gold-standard to perfuse deceased brain death donor (DBD) grafts. Histidine-Tryptophan-Ketoglutarate (HTK), formerly a cardioplegic infusion, has been also used in solid organ transplantation. Aim: To compare the outcomes of LT in our center using either HTK or UW solution. Patients and Methods: Retrospective study including 93 LT DBD liver grafts in 89 patients transplanted between March 1994 and July 2010. Forty-eight grafts were preserved with UW and 45 with HTK. Donor and recipient demographics, total infused volume, cold ischemia time, post-reperfusion biopsy, liver function tests, incidence of biliary complications, acute rejection and 12-month graft and patient survival were assessed. Preservation solution costs per liver graft were also recorded. Results: Donor and recipient demographics were similar. When comparing UW and HTK, no differences were observed in cold ischemia time (9.6 ± 3 and 8.7 ± 2 h respectively, p = 0.23), biliary complications, the incidence of acute rejection, primary or delayed graft dysfunction. Histology on post-reperfusion biopsies revealed no differences between groups. The infused volume was significantly higher with HTK than with UW (9 (5-16) and 6 (3-11) l, p < 0.001). The cost per procurement was remarkably lower using HTK. Conclusions: Perfusion of DBD liver grafts with HTK is clinically equivalent to UW, with a significant cost reduction.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Liver , Liver Transplantation/methods , Organ Preservation Solutions , Organ Preservation/instrumentation , Adenosine , Allopurinol , Brain Death , Glucose , Glutathione , Graft Survival/drug effects , Graft Survival/physiology , Insulin , Liver Failure/pathology , Mannitol , Potassium Chloride , Procaine , Raffinose , Retrospective Studies , Tissue Donors
8.
Rev. méd. Chile ; 137(8): 1031-1036, ago. 2009. tab
Article in Spanish | LILACS | ID: lil-531993

ABSTRACT

Background: Thyroid nodules are common and associated to a low risk of malignancy. Their clinical assessment usually includes a fine neddle aspiration biopsy (FNAB). Aim To identify ultrasonographic characteristics associated to papillary thyroid carcinoma (PTC) and generate a score that predicts the risk of PTC. Material and methods: Retrospective review of all fine needle aspiration biopsies of the thyroid performed in a lapse of two years. Biopsies that were conclusive for PTC were selected and compared with an equal amount of randomly selected biopsies that disclosed a benign diagnosis. Results: One hundred twenty two biopsies of a total of 1,498 were conclusive for PTC. Univariate analysis showed associations with PTC for the presence of micro-calcifications (Odds ratio (OR) 49.2: 95 percent confidence intervals (CI) 18.7-140.9), solid predominance (OR 25.1; 95 percent CI 6-220), hypoechogenicity (OR 23.5, 95 percent CI 6.5-122.6), irregular borders (OR 17, 95 percent CI 7.2-42.9), lymph node involvement (OR 12.3, 95 percent CI2.7-112), central vascularization (OR 12.2, 95 percent CI 4.8-33.3), local invasion and hyperechogenicity (OR 0.2; CI95 percent CI 0.03-0.6). Multivariate analysis disclosed microcalcifications (OR 28.1; CI 95 percent 8.9-89), hypoechogenicity (OR 9.4; 95 percent CI 1.5-59.5) and irregular borders (OR 4.7; CI 95 percent 1.5-15) as the variables independently associated with the presence of PTC. The prevalence of PTC in the presence of the three variables was 97.6 percent (Likelihood ratio (LR) 45) and 5.4 percent in their absence (LR 0.06). Conclusions: This scale predicts the presence or absence of PTC using simple ultrasound characteristics.


Subject(s)
Female , Humans , Male , Middle Aged , Carcinoma, Papillary , Thyroid Neoplasms , Biopsy, Fine-Needle , Chile , Carcinoma, Papillary/pathology , Epidemiologic Methods , Thyroid Gland/pathology , Thyroid Neoplasms/pathology
9.
Rev. méd. Chile ; 137(5): 666-671, mayo 2009. ilus
Article in Spanish | LILACS | ID: lil-521869

ABSTRACT

Eosinophilic esophagitis in adults (EE) is a disease of unknown cause, characterized by symptoms such as reflux and dysphagia that traditionally do not respond to antacid treatment. It affects mostly young men with a strong personal or familial history of a topy asthma and allergies. We repot three male patients aged 10, 14 and 15years, all with symptoms of dysphagia, two of them with chest pain caused by spasm of the esophagus, with heterogeneous endoscopic findings which included from leucoplakia to stenosis that needed endoscopic dilatation. All of them had abnormal findings in immunity studies (prick test or IgE levels). They received treatment based on diet measures, acid suppression and leukotriene inhibitors, with satisfactory clinical, endoscopic and histological response. EE should be suspected in children and adults with esophageal symptoms and personal or family history of allergy and asthma.


Subject(s)
Adolescent , Child , Humans , Male , Eosinophilia/pathology , Esophagitis/pathology , Acetates/therapeutic use , Esophagoscopy , Eosinophilia/drug therapy , Esophagitis/drug therapy , Omeprazole/therapeutic use , Quinolines/therapeutic use , /therapeutic use
10.
Rev. méd. Chile ; 137(4): 487-496, abr. 2009. ilus, tab, graf
Article in Spanish | LILACS | ID: lil-518582

ABSTRACT

Background: Surgical resection is the only treatment associated with long-term cure in patients with liver metastasis from colorectal cancer, achieving a 30% to 40% five years survival. Aim: To evaluate the results of liver resection for metastatic colorectalcancer in our centre. Patients and methods: Retrospective study. Epidemiological, perioperative and follow up data of patients undergoing liver resection for metastatic colorectalcancer between January 1990 and July 2007 were assessed. We compared the results between two periods; period 1 (1990-1997) and period 2 (1998-2007). Results: Sixty six patients aged61±12 years (46 males) underwent 75 resections. An anatomical excision was performed in 54 (72%) cases, a right hepatectomy in 18, an extended right hepatectomy in 11, a left hepatectomy in 1, and a segmentectomy in 24. In 24 (32%) patients the liver resection wassimultaneous with the colorectal cancer resection. Operative time was 221±86 min. Hospital stay was 11±5 days. Postoperative morbidity was 35% and surgical mortality was 0%. Resectionmargin was free of tumor in 53 (80%) patients. Five years overall and hepatic disease-free survival was 38% and 23%, respectively. In period 2, more anatomical resections than in period1 were performed (77% and 55%, respectively, p =0.04), without an increase in complications (35% and 34%, respectively; p =ns), but with a better five years survival (45% and 21%, respectively, p =0.04). Conclusions: Five years survival for excision of liver metastatic colorectal cancer in our center is similar to that reported abroad. During the second period there has been a trend toward more extensive resections which was associated with a better survival, without an increase in complications or mortality.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Colorectal Neoplasms/pathology , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Epidemiologic Methods , Liver Neoplasms/mortality , Treatment Outcome , Young Adult
11.
Rev. méd. Chile ; 136(11): 1424-1430, nov. 2008. graf, tab
Article in Spanish | LILACS | ID: lil-508962

ABSTRACT

Background: Early gastric cancer involves mucosa and submucosa, independent of lymph node involvement. Radical gastrectomy is the standard treatment. Aim: To assess long term survival of patients operated for an early gastric cancer. Material and methods: Retrospective Rev iew of medical and pathology records of patients subjected to a gastrectomy for an early gastric cancer, between 1975 and 2002. All were treated using a standardized protocol and staged according to 2002 TNM classification of the American Joint Committee of Cáncer (AJCC). Demographic and pathologic features, operation performed and long term survival were recorded. Survival was analyzed using Kaplan-Meier method. Results: The series is comprised by 64 males and 41 females aged 61 + 1 years. Tumor was located in the upper third of the stomach on 33 subjects and a total gastrectomy was performed in 53. Pathology showed an intestinal type adenocarcinoma in 82 and a diffuse type in 23. In patients with involvement of mucosa and submucosa, 24 ± 14 and 22 ± 14 lymph nodes were excised, respectively. Lymph node involvement was present in 8 percent and 22 percent of patients with involvement of mucosa and submucosa, respectively. Five years survival was 94 percent and 78 percent in patients without and with lymph node involvement, respectively. Survival among patients in stage IA and IB was 94 percent and 76 percent, respectively. Multivariate analysis showed that the lymph node involvement was an independent mortality risk factor. Conclusions: Total gastrectomy in patients with early gastric cancer is associated with a good survival. Lymph node involvement is a mortality risk factor.


Subject(s)
Female , Humans , Male , Middle Aged , Adenocarcinoma/mortality , Stomach Neoplasms/mortality , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Gastrectomy , Kaplan-Meier Estimate , Lymphatic Metastasis , Retrospective Studies , Risk Factors , Survivors , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery
12.
Rev. méd. Chile ; 136(10): 1317-1320, Oct. 2008. ilus
Article in Spanish | LILACS | ID: lil-503901

ABSTRACT

The association of gastric lymphoma and gastric adenocarcinoma in the same patient is uncommon. We report a 76 year-old male with a previous history of massive upper gastrointestinal bleeding who required a subtotal gastrectomy with Billroth II reconstruction in 1974. Pathology demonstrated a gastric ¡ympho-histiocytic non-Hodgkin's lymphoma. The patient received complementary radiotherapy and was followed with annual endoscopies for 23 years. In 2006, he presented with fatigue. An upper gastrointestinal endoscopy showed an ulcerated and proliferative lesión at the gastric stump. Biopsy demonstrated a gastric adenocarcinoma. Gastric stump resection with lymph node dissection was perfomed. Pathology of the excised specimen showed a moderately differentiated tubular adenocarcinoma of the gastrojejunal anastomoses which infiltrated up to the subserosa. Additionally lymphatic permeations were observed and 10 of the 16 excised lymph nodes were invaded by the tumor.


Subject(s)
Aged , Humans , Male , Adenocarcinoma/pathology , Lymphoma, Non-Hodgkin/pathology , Neoplasms, Second Primary/pathology , Stomach Neoplasms/pathology , Adenocarcinoma/surgery , Gastrectomy , Lymphoma, Non-Hodgkin/surgery , Neoplasms, Second Primary/surgery , Radiotherapy, Adjuvant , Stomach Neoplasms/radiotherapy , Stomach Neoplasms/surgery , Time Factors
13.
Rev. méd. Chile ; 136(4): 517-527, abr. 2008. ilus
Article in Spanish | LILACS | ID: lil-484929

ABSTRACT

Intraductal papillary mucinous neoplasm of the pancreas is characterized by a dilatation of the main pancreatic duct and/or secondary ducts, mucin production and the absence of ovarian ¡ike struma. The symptoms are non-specific and often the diagnosis is incidental. The treatment of choice is surgery, since these tumors may become malignant. The prognosis depends on the type of lesion, whether the excision is complete and lymph node involvement. The aim of this review is to analyze the clinical, diganostic, therapeutic and pathological characteristics of this disease.


Subject(s)
Female , Humans , Male , Middle Aged , Adenocarcinoma, Mucinous/diagnosis , Carcinoma, Pancreatic Ductal/diagnosis , Carcinoma, Papillary/diagnosis , Pancreatic Neoplasms/diagnosis , Adenocarcinoma, Mucinous/pathology , Adenocarcinoma, Mucinous/surgery , Biopsy, Fine-Needle , Carcinoma, Pancreatic Ductal/pathology , Carcinoma, Pancreatic Ductal/surgery , Carcinoma, Papillary/pathology , Carcinoma, Papillary/surgery , Diagnosis, Differential , Pancreatectomy , Prognosis , Pancreatic Ducts/pathology , Pancreatic Ducts , Pancreatic Ducts , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Survival Rate
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