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1.
Antioxidants (Basel) ; 13(2)2024 Feb 15.
Article in English | MEDLINE | ID: mdl-38397837

ABSTRACT

Carotenoids are ubiquitous and versatile isoprenoid compounds. The intake of foods rich in these pigments is often associated with health benefits, attributable to the provitamin A activity of some of them and different mechanisms. The importance of carotenoids and their derivatives for the production of foods and health-promotion through the diet is beyond doubt. In the new circular economy paradigm, the recovery of carotenoids in the biorefinery process is highly desirable, for which greener processes and solvents are being advocated for, considering the many studies being conducted at the laboratory scale. This review summarizes information on different extraction technologies (ultrasound, microwaves, pulsed electric fields, pressurized liquid extraction, sub- and supercritical fluid extraction, and enzyme-assisted extraction) and green solvents (ethyl lactate, 2-methyltetrahydrofuran, natural deep eutectic solvents, and ionic liquids), which are potential substitutes for more toxic and less environmentally friendly solvents. Additionally, it discusses the results of the latest studies on the sustainable green extraction of carotenoids. The conclusions drawn from the review indicate that while laboratory results are often promising, the scalability to real industrial scenarios poses a significant challenge. Furthermore, incorporating life cycle assessment analyses is crucial for a comprehensive evaluation of the sustainability of innovative extraction processes compared to industry-standard methods.

2.
Food Chem ; 405(Pt B): 134885, 2023 Mar 30.
Article in English | MEDLINE | ID: mdl-36442244

ABSTRACT

The impact of pressurized liquid extraction (PLE) and DMSO concentration (0, 30, 50, 100 %) on the yield of antioxidants and minerals from Chlorella were investigated. The results showed that PLE increased the antioxidant yield. Water extracted more proteins, while with 100 % DMSO more polyphenols, chlorophylls, and carotenoids were obtained. The efficiency coefficient (KPLE) results showed that PLE + 100 % DMSO was more suitable for the recovery of antioxidants and pigments from Chlorella (polyphenols 10.465 mg/g, chlorophyll a 6.206 mg/g, chlorophyll b 3.003 mg/g, carotenoids 0.971 mg/g). Thus, PLE + 100 % DMSO was used for recovery studies on Spirulina, Chlorella, and Phaeodactylum tricornutum. Fucoxanthin, ß-carotene, zeaxanthin, and lutein were the major carotenoids in P. tricornutum, Spirulina, and Chlorella, respectively. Regarding the extraction of minerals, Relative Nutrient Values results were calculated based on Recommended Dietary Allowances. The results indicated that the extracts could be used as a mineral source for different populations.


Subject(s)
Chlorella , Microalgae , Spirulina , Animals , Dimethyl Sulfoxide , Carotenoids , Antioxidants , Polyphenols , Chlorophyll A , Decapodiformes , Chlorophyll
3.
Obes Surg ; 32(8): 2598-2604, 2022 08.
Article in English | MEDLINE | ID: mdl-35687255

ABSTRACT

PURPOSE: Bariatric surgery is currently considered the most effective and durable treatment option for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) has become a popular technique and may currently be the most frequently practiced surgical operation to treat obesity. However, no objective analyses of its learning curve have been reported. OBJECTIVE: to analyze the learning curve for LSG. MATERIALS AND METHODS: We included all LSGs performed in our hospital (University Hospital, Spain; Public Practice) from April 2013 to February 2016. The learning curve for LSG was evaluated using cumulative sum (CUSUM) analysis. All variables among the learning curve phases were compared. RESULTS: According to the CUSUM analysis, the learning curve was divided into three unique phases: early learning (the initial 26 patients), acquisition of skills (the middle 30 patients), and mastery of technique (the final 56 patients). The operative time and gastric stenosis significantly decreased with progression of the learning curve without differences in the 30-day postoperative complication rate, postoperative stay, or weight loss. CONCLUSION: According to this study, the learning curve for LSG can be divided into 3 distinct phases, and about 25 patients are needed to demonstrate an improvement in surgical skill.


Subject(s)
Laparoscopy , Obesity, Morbid , Gastrectomy/methods , Humans , Laparoscopy/methods , Learning Curve , Obesity, Morbid/surgery , Postoperative Complications/epidemiology , Postoperative Complications/surgery , Retrospective Studies , Treatment Outcome
4.
Rev Esp Enferm Dig ; 111(10): 789-794, 2019 10.
Article in English | MEDLINE | ID: mdl-31566411

ABSTRACT

Barrett's esophagus (BE) is a controversial condition. The significance of this condition lies in its premalignant potential, so it is important that clinically applicable biomarkers be identified for early detection and targeted prevention. Dysplasia is currently used as main biomarker, but others most recently surveyed in cancer also include microRNAs. Classically, BE was considered to be an acquired disease related to pathological gastroesophageal acid and bile reflux. However, some cases are associated with genetic predisposition, representing an inherited, familial form of BE. The actual gene, or genes, involved in this condition have not yet been identified. Main therapeutic options include medical treatment and antireflux surgery. Both types of treatment are equally efficient in controlling symptoms and neither is able to cause the metaplastic segment to disappear, which is why the risk of malignancy remains. However, we may use endoscopic radiofrequency to eradicate BE and replace it by the typical squamous epithelium of the esophagus. The currently accepted indications of radiofrequency in BE include low- and high-grade dysplasia, but not Barrett's esophagus without dysplasia. In conclusion, BE may have two different presentations: environmental ("human", reflux) or sporadic BE, which is the most common form, and genetic ("divine", inherited) or familiar BE, less common but with a greater risk for malignancy. As they might be two different diseases, surveillance programs and treatments should also be different.


Subject(s)
Barrett Esophagus/etiology , Barrett Esophagus/therapy , Barrett Esophagus/genetics , Esophageal Neoplasms/etiology , Fundoplication/methods , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/surgery , Gene-Environment Interaction , Genetic Markers , Humans , MicroRNAs/metabolism , Pedigree , Proton Pump Inhibitors/therapeutic use , Radiofrequency Ablation
5.
Rev. esp. enferm. dig ; 111(10): 789-794, oct. 2019. graf
Article in English | IBECS | ID: ibc-190452

ABSTRACT

Barrett's esophagus (BE) is a controversial condition. The significance of this condition lies in its premalignant potential, so it is important that clinically applicable biomarkers be identified for early detection and targeted prevention. Dysplasia is currently used as main biomarker, but others most recently surveyed in cancer also include microRNAs. Classically, BE was considered to be an acquired disease related to pathological gastroesophageal acid and bile reflux. However, some cases are associated with genetic predisposition, representing an inherited, familial form of BE. The actual gene, or genes, involved in this condition have not yet been identified. Main therapeutic options include medical treatment and antireflux surgery. Both types of treatment are equally efficient in controlling symptoms and neither is able to cause the metaplastic segment to disappear, which is why the risk of malignancy remains. However, we may use endoscopic radiofrequency to eradicate BE and replace it by the typical squamous epithelium of the esophagus. The currently accepted indications of radiofrequency in BE include low- and high-grade dysplasia, but not Barrett's esophagus without dysplasia. In conclusion, BE may have two different presentations: environmental ("human", reflux) or sporadic BE, which is the most common form, and genetic ("divine", inherited) or familiar BE, less common but with a greater risk for malignancy. As they might be two different diseases, surveillance programs and treatments should also be different


No disponible


Subject(s)
Humans , Barrett Esophagus/genetics , Esophageal Neoplasms/genetics , Adenocarcinoma/genetics , Barrett Esophagus/therapy , Fundoplication/methods , Gastroesophageal Reflux/epidemiology , Genetic Predisposition to Disease , Gene-Environment Interaction , Genetic Markers
6.
Cir. Esp. (Ed. impr.) ; 97(8): 445-450, oct. 2019. tab
Article in Spanish | IBECS | ID: ibc-187618

ABSTRACT

Existe una importante controversia en el manejo quirúrgico del cáncer de cardias. Parece unánime que los tumores tipo i de Siewert se intervengan como un cáncer de esófago y los Siewert III como un cáncer gástrico. Sin embargo, sobre el «verdadero» cáncer de cardias o Siewert II no existe consenso. Es obvia la necesidad de un margen proximal y distal libre, así como una correcta linfadenectomía. Para algunos es necesaria la esofaguectomía para realizar una correcta cirugía oncológica radical, pero otros autores defienden que es suficiente con un abordaje abdominal para realizar una gastrectomía total y esofaguectomía distal. Tanto los trabajos publicados con cierta antigüedad como aquellos más recientes no aclaran este dilema y sus resultados son contradictorios. El hecho de realizar un tratamiento quimioterápico previo a la cirugía, puede reducir el tamaño tumoral y la presencia de adenopatías, por lo que las opciones quirúrgicas pueden haber cambiado en los últimos años


There is significant controversy in the management of cardiac cancer. It seems unanimous that Siewert type I tumors be operated on as cancer of the esophagus and Siewert type III as gastric cancer. However, for "true" cancer of the gastric cardia or Siewert II, the authors do not agree. There is the obvious need for free proximal and distal margins, as well as correct lymphadenectomy. For some, esophagectomy is necessary to perform correct radical oncological surgery, but other authors defend that an abdominal approach is sufficient to perform total gastrectomy and distal esophagectomy. Recent and older papers published do not clarify this issue, and their results are contradictory. Chemotherapy prior to surgery can reduce the size of the tumor and the presence of lymphadenopathies


Subject(s)
Humans , Cardia/surgery , Esophageal Neoplasms/surgery , Esophagectomy/methods , Esophagogastric Junction/surgery , Gastrectomy/methods , Stomach Neoplasms/surgery , Cardia/pathology , Esophageal Neoplasms/classification , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/pathology , Esophagogastric Junction/pathology , Stomach Neoplasms/classification , Stomach Neoplasms/drug therapy , Stomach Neoplasms/pathology , Quality of Life , Tumor Burden/drug effects
7.
Cir Esp (Engl Ed) ; 97(8): 445-450, 2019 Oct.
Article in English, Spanish | MEDLINE | ID: mdl-31027834

ABSTRACT

There is significant controversy in the management of cardiac cancer. It seems unanimous that Siewert type I tumors be operated on as cancer of the esophagus and Siewert type III as gastric cancer. However, for "true" cancer of the gastric cardia or Siewert II, the authors do not agree. There is the obvious need for free proximal and distal margins, as well as correct lymphadenectomy. For some, esophagectomy is necessary to perform correct radical oncological surgery, but other authors defend that an abdominal approach is sufficient to perform total gastrectomy and distal esophagectomy. Recent and older papers published do not clarify this issue, and their results are contradictory. Chemotherapy prior to surgery can reduce the size of the tumor and the presence of lymphadenopathies.


Subject(s)
Cardia/surgery , Esophageal Neoplasms/surgery , Esophagectomy/methods , Esophagogastric Junction/surgery , Gastrectomy/methods , Stomach Neoplasms/surgery , Cardia/pathology , Esophageal Neoplasms/classification , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/pathology , Esophagogastric Junction/pathology , Humans , Lymph Node Excision/methods , Margins of Excision , Quality of Life , Stomach Neoplasms/classification , Stomach Neoplasms/drug therapy , Stomach Neoplasms/pathology , Treatment Outcome , Tumor Burden/drug effects
8.
Rev. esp. enferm. dig ; 111(3): 189-192, mar. 2019. ilus, tab, graf
Article in Spanish | IBECS | ID: ibc-189824

ABSTRACT

Introducción: el cáncer gástrico difuso hereditario (CGDH) constituye uno de los síndromes de cáncer hereditario recientemente comunicados. Aquellos pacientes con sospecha de CGDH deben ser vigilados con endoscopia y toma múltiples de biopsias. Como alternativa, algunos autores proponen la realización de gastrectomía profiláctica (GP) en los portadores de la enfermedad. El objetivo de este trabajo es presentar nuestra experiencia con una familia portadora de la mutación CDH1 a los que se realizó una GP. Pacientes y métodos: nuestro caso índice corresponde a una mujer de 34 años que se diagnosticó de un adenocarcinoma gástrico difuso con carcinomatosis masiva. Presentaba antecedentes familiares de adenocarcinoma gástrico en siete ascendientes. Se realizó un estudio genético mediante secuenciación de CDH1, en el cual se encontró la mutación c1577G>A en el exón 11 del gen CDH1. Resultados: esta mutación estaba también presente en otros seis familiares de la paciente, a los que se les realizó una gastrectomía profiláctica. La anatomía patológica de los estómagos de estos pacientes informó de múltiples focos microscópicos de adenocarcinoma en cinco de ellos, a pesar de que en las numerosas endoscopias realizadas antes de la cirugía no fueron detectados. Conclusiones: recomendamos realizar una gastrectomía profiláctica en los pacientes portadores del gen CDH1 a pesar de ausencia de lesiones tumorales en el screening endoscópico


Introduction: hereditary diffuse gastric cancer (HDGC) is a recently reported hereditary cancer syndrome. Patients with suspected HDGC must be under surveillance via endoscopy and multiple biopsies. As an alternative, some studies suggest prophylactic gastrectomy (PG) for disease carriers. The goal of this article was to report our experience with a CDH1 mutation positive family who underwent PG. Patients and methods: the index case was a 34-year-old female diagnosed with diffuse gastric adenocarcinoma and massive carcinomatosis. There was a family history of gastric adenocarcinoma in seven family members. A genetic study identified the c.1577G>A mutation, in exon 11 of the CDH1 gene via sequencing analysis. Results: this mutation was also present in other six family members, who subsequently underwent prophylactic gastrectomy. The pathology study of resected gastric segments revealed multiple microscopic foci of adenocarcinoma in five of these individuals. These foci were not detected in the multiple endoscopies performed before surgery. Conclusions: we recommend prophylactic gastrectomy for CDH1 mutation carriers even in the absence of lesions during endoscopic screening


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Gastrectomy/statistics & numerical data , Stomach Neoplasms/surgery , Neoplastic Syndromes, Hereditary/surgery , Cadherins/analysis , Cdh1 Proteins/analysis , Stomach Neoplasms/genetics , Neoplastic Syndromes, Hereditary/genetics , Genetic Markers , Early Detection of Cancer/methods
9.
Rev Esp Enferm Dig ; 111(3): 189-192, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30466290

ABSTRACT

INTRODUCTION: hereditary diffuse gastric cancer (HDGC) is a recently reported hereditary cancer syndrome. Patients with suspected HDGC must be under surveillance via endoscopy and multiple biopsies. As an alternative, some studies suggest prophylactic gastrectomy (PG) for disease carriers. The goal of this article was to report our experience with a CDH1 mutation positive family who underwent PG. PATIENTS AND METHODS: the index case was a 34-year-old female diagnosed with diffuse gastric adenocarcinoma and massive carcinomatosis. There was a family history of gastric adenocarcinoma in seven family members. A genetic study identified the c.1577G>A mutation, in exon 11 of the CDH1 gene via sequencing analysis. RESULTS: this mutation was also present in other six family members, who subsequently underwent prophylactic gastrectomy. The pathology study of resected gastric segments revealed multiple microscopic foci of adenocarcinoma in five of these individuals. These foci were not detected in the multiple endoscopies performed before surgery. CONCLUSIONS: we recommend prophylactic gastrectomy for CDH1 mutation carriers even in the absence of lesions during endoscopic screening.


Subject(s)
Adenocarcinoma/genetics , Adenocarcinoma/surgery , Antigens, CD/genetics , Cadherins/genetics , Gastrectomy , Mutation , Stomach Neoplasms/genetics , Stomach Neoplasms/surgery , Adenocarcinoma/pathology , Adult , Exons , Female , Humans , Male , Middle Aged , Neoplastic Syndromes, Hereditary/genetics , Neoplastic Syndromes, Hereditary/pathology , Neoplastic Syndromes, Hereditary/surgery , Pedigree , Stomach Neoplasms/pathology
10.
Cir. Esp. (Ed. impr.) ; 95(10): 588-593, dic. 2017. ilus, graf
Article in Spanish | IBECS | ID: ibc-169989

ABSTRACT

Introducción: Una de las complicaciones más graves tras la cirugía de resección esofagogástrica es la dehiscencia de la anastomosis. El uso de apósitos adhesivos podría constituir una ayuda eficaz para resolver esta complicación. Nuestro objetivo ha sido realizar un estudio experimental encaminado a estudiar dichos mecanismos en un modelo de anastomosis esofágica en rata. Métodos: Se han utilizado un total de 50 ratas Sprague-Dawley divididas en 2 grupos, grupo Tachosil(R) (n = 25) y grupo control (n = 25). Tras la sección del esófago abdominal se realizó una anastomosis esófago-gástrica monoplano, reforzando con una tira de 1cm de Tachosil(R) envolviendo la anastomosis en el primer grupo. Se realizó un estudio funcional mediante manometría, así como un estudio histopatológico e inmunohistoquímico para factores angiogénicos, fibrogénicos y proliferativos. Resultados: La mortalidad en nuestra serie alcanzó un 8% en el grupo en el que fue aplicado apósito de colágeno, frente a un 36% del grupo control. Al realizar la manometría esofágica, la presión de dehiscencia fue mayor en las anastomosis reforzadas. En el estudio microscópico, en el grupo en el que se aplicó apósito de colágeno se apreció una profusa reacción inflamatoria con abundantes PMN y macrófagos rodeados por una matriz conectiva con fibroblastos y vasos sanguíneos. La expresión de VEGF y FGF1 y FGF2 fue sensiblemente mayor en las anastomosis con apósito de colágeno. Conclusiones: Estos resultados indican que la aplicación de apósito de colágeno facilita los fenómenos de reparación tisular, por lo que podría ser de gran utilidad como refuerzo de las anastomosis esofagogástricas para la prevención de dehiscencias (AU)


Introduction: One of the most severe complications after esophaguectomy is anastomotic dehiscence. The use of collagen sponges could be an effective way to resolve this complication. Our objective was to perform an experimental model of esophageal anastomosis in rats to study these mechanisms. Methods: A total of 50 Sprague-Dawley rats were used divided into 2 groups, Tachosil(R) group (n = 25) and control group (n = 25). After the section of the abdominal esophagus a single-layer esophago-gastric anastomosis was performed reinforced with 1cm of Tachosil(R) wrapping the anastomosis in group 1. A functional study was performed using manometry as well as histopathological and immunohistochemical studies for angiogenic, fibrogenic and growth factors. Results: The mortality in our series was 8% in the collagen dressing group, compared to 36% in the control group. When esophageal manometry was performed, the dehiscence pressure was higher in the reinforced anastomosis, On microscopical analysis, in the collagen dressing group a profuse inflammatory reaction with abundant neutrophils and macrophages surrounded by a connective matrix with fibroblasts and blood vessels was observed, The expression of VEGF, FGF1 and FGF2 was noticeably higher in the collagen dressing group. Conclusions: These results show that the application of collagen dressing facilitates tissue reparation phenomena, and therefore could be very useful as a reinforcement of esophago-gastric anastomosis to prevent dehiscence (AU)


Subject(s)
Animals , Rats , Histocytochemistry/methods , Immunohistochemistry/methods , Collagen/therapeutic use , Anastomosis, Surgical/methods , Disease Models, Animal , Esophagostomy/methods , Bandages , Esophagectomy
11.
Cir Esp ; 95(10): 588-593, 2017 Dec.
Article in English, Spanish | MEDLINE | ID: mdl-29117903

ABSTRACT

INTRODUCTION: One of the most severe complications after esophaguectomy is anastomotic dehiscence. The use of collagen sponges could be an effective way to resolve this complication. Our objective was to perform an experimental model of esophageal anastomosis in rats to study these mechanisms. METHODS: A total of 50 Sprague-Dawley rats were used divided into 2 groups, Tachosil® group (n=25) and control group (n=25). After the section of the abdominal esophagus a single-layer esophago-gastric anastomosis was performed reinforced with 1cm of Tachosil® wrapping the anastomosis in group 1. A functional study was performed using manometry as well as histopathological and immunohistochemical studies for angiogenic, fibrogenic and growth factors. RESULTS: The mortality in our series was 8% in the collagen dressing group, compared to 36% in the control group. When esophageal manometry was performed, the dehiscence pressure was higher in the reinforced anastomosis, On microscopical analysis, in the collagen dressing group a profuse inflammatory reaction with abundant neutrophils and macrophages surrounded by a connective matrix with fibroblasts and blood vessels was observed, The expression of VEGF, FGF1 and FGF2 was noticeably higher in the collagen dressing group. CONCLUSIONS: These results show that the application of collagen dressing facilitates tissue reparation phenomena, and therefore could be very useful as a reinforcement of esophago-gastric anastomosis to prevent dehiscence.


Subject(s)
Bandages , Collagen , Esophagus/anatomy & histology , Esophagus/surgery , Fibrinogen , Thrombin , Anastomosis, Surgical/methods , Animals , Drug Combinations , Immunohistochemistry , Male , Models, Animal , Rats , Rats, Sprague-Dawley
14.
Ann Surg ; 257(5): 886-93, 2013 May.
Article in English | MEDLINE | ID: mdl-23059500

ABSTRACT

OBJECTIVE: The aim of this study is to identify a set of microRNAs (miRNAs) as prognostic molecular biomarkers for the progression of Barrett esophagus (BE) to esophageal adenocarcinoma (EAC) to rationalize the surveillance programs in patients with BE. BACKGROUND: Histological dysplasia is currently used as the main biomarker to identify the BE patients at high risk for developing EAC. Although miRNA expression profiles in BE and EAC have been reported, it has not been established which set of miRNAs could constitute a robust diagnostic test to predict the progression of BE to EAC. METHODS: miRNAs associated with progression of BE to EAC were identified using miRNA sequencing analysis. Further validation by quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed in 2 groups of BE patients who either developed or did not develop adenocarcinoma after at least 5 years of follow-up. RESULTS: Twenty-three miRNAs were identified by miRNA sequencing analysis in the carcinogenesis process associated with BE. qRT-PCR analysis using independent tissue samples confirmed differential expression for 19 of them (miR-let-7c, 7, 146a, 149, 153, 192, 192*, 194, 194*, 196a, 196b, 200a, 203, 205, 215, 424, 625, 625*, and 944). However, only miR-192, 194, 196a, and 196b showed a significantly higher expression in BE samples from patients with progression to EAC compared with those who did not progress to EAC. CONCLUSIONS: These findings suggest that the expression pattern of a modest number of miRNAs in metaplasia biopsies could identify the BE patients at high risk for developing EAC. Therefore, it has potential use for the control and treatment of this malignancy.


Subject(s)
Adenocarcinoma/genetics , Barrett Esophagus/genetics , Biomarkers, Tumor/metabolism , Esophageal Neoplasms/genetics , Gene Expression Regulation, Neoplastic , MicroRNAs/metabolism , Precancerous Conditions/genetics , Adenocarcinoma/metabolism , Adenocarcinoma/pathology , Barrett Esophagus/metabolism , Barrett Esophagus/pathology , Computational Biology , Disease Progression , Esophageal Neoplasms/metabolism , Esophageal Neoplasms/pathology , Follow-Up Studies , Humans , Logistic Models , Multivariate Analysis , Precancerous Conditions/metabolism , Precancerous Conditions/pathology , ROC Curve , Reverse Transcriptase Polymerase Chain Reaction , Sequence Analysis, RNA , Transcriptome
15.
Ann Surg ; 255(5): 916-21, 2012 May.
Article in English | MEDLINE | ID: mdl-22415421

ABSTRACT

OBJECTIVE: This study aims to compare some validated biomarkers of malignancy (Ki-67, p53, and apoptosis) between 2 groups of patients with Barrett's esophagus (BE) undergoing randomly medical or surgical treatment. BACKGROUND: The treatment of choice to prevent the malignant progression of BE remains controversial. Translational studies using biomarkers associated with the metaplasia-tumor pathway could be useful to provide some information in this regard. METHODS: The study group consisted of 45 patients: 20 under medical treatment with 40 mg/day of proton pump inhibitors (PPIs) and 25 after Nissen fundoplication (NFP). After a median follow-up of 8 years (range, 5-10 years), the values of Ki-67, p53, and apoptosis were analyzed in all patients before treatment (n = 45) and then 1 year (n = 45), 3 years (n = 45), 5 years (n = 45), and 10 years (n = 25) afterwards in both groups of treatment. These values were also analyzed in 2 subgroups of patients with successful medical and surgical treatment. RESULTS: Both Ki-67 and p53 remained stable after NFP, whereas they increased progressively in patients under PPIs with statistically significant differences between the 2 groups. Conversely, the apoptotic index increased progressively after NFP and decreased in the patients under PPIs with significant differences at 3, 5, and 10 years of follow-up. On comparing the subgroups of successful treatment the same differences were found. CONCLUSIONS: Barrett's epithelium remains more stable after a long-term follow-up in patients with BE treated surgically than in those under PPIs even in the absence of abnormal rates of acid reflux.


Subject(s)
Barrett Esophagus/metabolism , Biomarkers, Tumor/metabolism , Adolescent , Adult , Aged , Apoptosis , Barrett Esophagus/drug therapy , Barrett Esophagus/pathology , Barrett Esophagus/surgery , Disease Progression , Esophageal Neoplasms/prevention & control , Female , Follow-Up Studies , Fundoplication , Humans , Ki-67 Antigen/metabolism , Male , Middle Aged , Proton Pump Inhibitors/therapeutic use , Tumor Suppressor Protein p53/metabolism , Young Adult
16.
Cir Esp ; 84(4): 201-9, 2008 Oct.
Article in Spanish | MEDLINE | ID: mdl-18928770

ABSTRACT

BACKGROUND AND OBJECTIVE: A new catheter-free outpatient oesophageal pH-meter system (Bravo) has recently been developed. The objective of this study is to test the tolerance, safety and efficacy of the system in the measurement of gastric-oesophageal reflux by comparing it with a conventional pH system. PATIENTS AND METHOD: The study was performed on a control group consisting of 10 healthy volunteers (group 1) and in a group of 40 patients with symptoms of gastric-oesophageal reflux disease (groups 2 and 3). An upper digestive system endoscopy, oesophageal manometry and oesophageal pH measurements with a conventional system and/or with the Bravo catheter-free system, was performed on all patients. All patients who had both tests done (groups 1 and 2) filled in a questionnaire on any physical problems and changes in their daily activity. RESULTS: The test tolerance was higher with the Bravo system in the 9 parameters studied. In the group of healthy volunteers (group 1), the median (range) of the total percentage of pH < 4 was 1.1% (0.5-3.1) with the conventional pH and 1.7% (0-3.4) with the Bravo. When comparing the patients with symptoms of gastric-oesophageal reflux disease (group 2) with those who had only one type of pH measurement made, the acid reflux was significantly higher in patients with Barrett's oesophagus than in the rest of the groups, with conventional pH as well as with the Bravo. If we analyse the patient group with disease due to gastric-oesophageal reflux with those on whom both techniques were used (group 3), 7 of the 10 patients had a pathological reflux that only showed up on measuring pH with the Bravo system. CONCLUSIONS: Catheter-free pH measurements (Bravo) is better tolerated and with better satisfaction for the healthy volunteers and patients than with conventional PH, even, on occasions being more efficient for studying acid reflux due to the lower incidence of negative results.


Subject(s)
Barrett Esophagus/diagnosis , Esophageal pH Monitoring/instrumentation , Gastroesophageal Reflux/diagnosis , Monitoring, Ambulatory , Telemetry/instrumentation , Adolescent , Adult , Capsules , Data Interpretation, Statistical , Female , Humans , Male , Middle Aged , Patient Satisfaction , Radiography, Abdominal , Radiography, Thoracic , Safety , Statistics, Nonparametric , Surveys and Questionnaires
17.
Cir. Esp. (Ed. impr.) ; 84(4): 201-209, oct. 2008. ilus, tab
Article in Es | IBECS | ID: ibc-67911

ABSTRACT

Fundamento y objetivo. Recientemente se ha desarrollado un nuevo sistema de pH-metría esofágica ambulatoria sin catéter, el sistema Bravo®. El objetivo de este estudio es comprobar la tolerancia, la seguridad y la eficacia del sistema en la medición del reflujo gastroesofágico, en comparación con la pH-metría convencional. Pacientes y método. El estudio se realizó en un grupo control constituido por 10 voluntarios sanos (grupo 1) y en un grupo de 40 pacientes con síntomas de enfermedad por reflujo gastroesofágico (grupos 2 y 3). A todos los pacientes se les realizó endoscopia digestiva alta, manometría esofágica y pH-metría esofágica convencional y/o pH-metría sin catéter con el sistema Bravo®. Todos los pacientes a los que se realizaron ambas pruebas (grupos 1 y 3) rellenaron un cuestionario sobre molestias físicas y alteraciones de su actividad diaria. Resultados. La tolerancia de la prueba fue mejor con el sistema Bravo® en 9 de los 10 parámetros estudiados. En el grupo de voluntarios sanos (grupo 1), la mediana (intervalo) del porcentaje total de pH < 4 fue del 1,1% (0,5-3,1%) con la pH convencional y el 1,7% (0-3,4%) con el sistema Bravo®. En cuanto a los pacientes con síntomas de enfermedad con reflujo gastroesofágico (grupo 2) a los que se realizó sólo un tipo de pH-metría, el reflujo ácido fue significativamente mayor en los pacientes con esófago de Barrett que en el resto de los grupos, tanto con la pH convencional como con el Bravo®. Si analizamos al grupo de pacientes con enfermedad por reflujo gastroesofágico a los que se realizaron ambas técnicas (grupo 3), 7 de los 10 pacientes tenían un reflujo patológico que sólo se evidenció al realizar pH-metría con el sistema Bravo®. Conclusiones. La pH-metría sin sonda (Bravo®) es mejor tolerada y de mayor satisfacción para los voluntarios sanos y los pacientes que la pH-metría convencional, en ocasiones incluso es más eficaz para el estudio del reflujo ácido por la menor frecuencia de resultados negativos (AU)


Background and objective. A new catheter-free outpatient oesophageal pH-meter system (Bravo®), has recently been developed. The objective of this study is to test the tolerance, safety and efficacy of the system in the measurement of gastric-oesophageal reflux by comparing it with a conventional pH system. Patients and method. The study was performed on a control group consisting of 10 healthy volunteers (group 1) and in a group of 40 patients with symptoms of gastric-oesophageal reflux disease (groups 2 and 3). An upper digestive sytem endoscopy, oesophageal manometry and oesophageal pH measurements with a conventional system and/or with the Bravo® catheter-free system, was performed on all patients. All patients who had both tests done (groups 1 and 2) filled in a questionnaire on any physical problems and changes in their daily activity. Results. The test tolerance was higher with the Bravo® system in the 9 parameters studied. In the group of healthy volunteers (group 1), the median (range) of the total percentage of pH < 4 was 1.1% (0.5-3.1) with the conventional pH and 1.7% (0-3.4) with the Bravo®. When comparing the patients with symptoms of gastric-oesophageal reflux disease (group 2) with those who had only one type of pH measurement made, the acid reflux was significantly higher in patients with Barrett’s oesophagus than in the rest of the groups, with conventional pH as well as with the Bravo®. If we analyse the patient group with disease due to gastric-oesophageal reflux with those on whom both techniques were used (group 3), 7 of the 10 patients had a pathological reflux that only showed up on measuring pH with the Bravo® system. Conclusions. Catheter-free pH measurements (Bravo®) is better tolerated and with better satisfaction for the healthy volunteers and patients than with conventional PH, even, on occasions being more efficient for studying acid reflux due to the lower incidence of negative results (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Ambulatory Surgical Procedures/instrumentation , Ambulatory Surgical Procedures/methods , Ambulatory Surgical Procedures , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/epidemiology , Manometry/methods , Surveys and Questionnaires , Gastrointestinal Motility/physiology , Gastrointestinal Motility/radiation effects , Safety/standards , Efficacy/standards , Efficacy/statistics & numerical data , Radiography, Thoracic
18.
J Clin Gastroenterol ; 42(7): 806-9, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18385604

ABSTRACT

Barrett's esophagus is an acquired condition fundamentally related to the presence of severe and prolonged pathologic acid and biliary gastro-esophageal reflux. However, genetic factors may also play a role in some cases. The aim of this study is to present 3 generations of a Spanish family with the largest number of members so far reported with Barrett's esophagus or esophageal adenocarcinoma. Of the 24 members of this family studied over 3 generations, 6 patients developed esophageal adenocarcinoma, 4 Barrett's esophagus, 6 clinical symptoms of gastro-esophageal reflux disease without Barrett's esophagus, and 8 were asymptomatic. In conclusion, patients with familial Barrett's esophagus get the disease more severely with a high rate of malignancy and, therefore, the endoscopic surveillance should be closer than in cases of nonfamilial Barrett's esophagus.


Subject(s)
Adenocarcinoma , Barrett Esophagus , Esophageal Neoplasms , Family , Risk , Adenocarcinoma/etiology , Adenocarcinoma/genetics , Adolescent , Adult , Aged, 80 and over , Barrett Esophagus/complications , Barrett Esophagus/genetics , Child , Esophageal Neoplasms/etiology , Esophageal Neoplasms/genetics , Female , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/genetics , Humans , Male , Middle Aged , Pedigree , Spain
19.
Ann Surg ; 247(2): 258-64, 2008 Feb.
Article in English | MEDLINE | ID: mdl-18216530

ABSTRACT

OBJECTIVE: To present the objectively assessed very long-term results of a prospective study of 149 patients with achalasia of the cardia who underwent Heller myotomy and posterior partial fundoplication. SUMMARY BACKGROUND DATA: Very few studies evaluate objectively the very long-term results to analyze whether the effectiveness of Heller myotomy is maintained with the passing of time. METHODS: The study group consisted of 149 patients who underwent a Heller myotomy plus a posterior partial fundoplication through a laparotomy. The median follow-up was 6 years (range, 1-27 years). Follow-up period was over 10 years in 53 patients and over 15 in 36. Clinical, radiologic, endoscopic, manometric, and pHmetric evaluations were performed postoperatively. RESULTS: Satisfactory results were higher than 90% up to 5 years. From that time on results gradually decreased to a 75% rate after 15 years (P < 0.001) due to either heartburn or dysphagia. Both the esophageal diameter and the mean resting pressure of the lower esophageal sphincter decreased postoperatively with no significant changes during follow-up. Esophagitis appeared in 11% of the patients (47% of them being asymptomatic) and 24-hour pH monitoring showed pathologic rates of acid reflux in 14% of patients, 58% of them being asymptomatic. Both esophagitis and pathologic rates of reflux appeared in >40% of the patients late in the follow-up. CONCLUSION: Results after Heller myotomy plus posterior partial fundoplication deteriorate with time, although we achieved a 75% of satisfactory results after >15 years of follow-up. Our study highlights the importance of life long follow-up and the objective assessment of the results.


Subject(s)
Cardia/surgery , Esophageal Achalasia/surgery , Fundoplication/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Endoscopy, Gastrointestinal , Esophageal Achalasia/metabolism , Esophageal Achalasia/physiopathology , Esophagus/pathology , Esophagus/physiopathology , Esophagus/surgery , Female , Follow-Up Studies , Gastric Acid/metabolism , Gastric Acidity Determination , Humans , Hydrogen-Ion Concentration , Male , Manometry , Middle Aged , Patient Satisfaction , Postoperative Period , Pressure , Prospective Studies , Severity of Illness Index , Time Factors , Treatment Outcome
20.
Cir. Esp. (Ed. impr.) ; 76(6): 400-403, dic. 2004. ilus
Article in Es | IBECS | ID: ibc-35912

ABSTRACT

La disfagia orofaríngea es una enfermedad miopática hereditaria transmitida de forma autosómica dominante que cursa con ptosis palpebral, disfagia orofaríngea y debilidad proximal de las extremidades. Fue descrita por primera vez porTaylor en 1915, y en 1998, Brais describió la alteración genética causante de esta enfermedad, una expansión anómala de la tripleta de nucleóticos guanidina-citosina-guanidima (GCG) en el gen PABP2 del cromosoma 14. Los individuos normales poseen la forma homocigótica GCG6 de esta tripleta, mientras que los pacientes con el síndrome descrito presentan la forma heterocigótica GCG6-GCG9. Para el estudio de la disfagia orofaríngea es aconsejable realizar una endoscopia digestiva alta, una videorradiología con bario y una manometría esofágica. Presentamos los casos de 3 hermanos de una misma familia diagnosticados de distrofia oculofaríngea confirmada genéticamente, a los que se realizó una miotomía del músculo cricofaríngeo para conseguir una deglución normal (AU)


Subject(s)
Aged , Female , Male , Humans , Muscular Dystrophy, Oculopharyngeal/surgery , Muscular Dystrophy, Oculopharyngeal/genetics , Pharyngeal Muscles/surgery , Deglutition Disorders/etiology , Chromosomes, Human, Pair 14/genetics
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