ABSTRACT
BACKGROUND: Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS: From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS: Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS: This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.
Subject(s)
Laparoscopy , Liver Neoplasms , Argentina , Asia , Brazil , Chile , Colombia , Europe , Hepatectomy , Humans , Liver , Liver Neoplasms/surgery , PeruABSTRACT
Rituximab, intravenous immunoglobulin (IVIG) and rabbit antithymocyte globulin (rATG) all have been suggested to have an effect on antibody producing cells, however, supporting data are lacking. To assess the impact of these agents on splenic B-cell populations in vivo, we retrospectively examined 25 spleens removed from patients treated with these agents as part of desensitization protocols in either ABO incompatible or positive crossmatch living donor kidney transplantation. These were compared to control (CTL) spleens removed for trauma. CTLs and spleens removed at transplant after multiple pretransplant plasmaphereses (PP) plus low-dose IVIG showed similar large numbers of naïve B cells (CD20+ and CD79+), plasma cells (CD138+) and memory B cells (CD27+ cells). Adding rituximab to this PP/IVIG regimen reduced the number naïve B cells, but had no effect on memory or plasma cells. Combination treatment (PP/IVIG, rituximab and rATG) showed a trend toward the reduction of CD27+ cells, but again plasma cells were unchanged. We conclude that none of these protocols reduces splenic plasma cells in vivo. PP/low-dose IVIG does not alter splenic B cells, but the addition of rituximab decreases mature B cells. Memory B cells may be affected by combination therapy including rATG and requires further study.
Subject(s)
B-Lymphocyte Subsets/immunology , B-Lymphocyte Subsets/pathology , Desensitization, Immunologic/methods , Spleen/pathology , Animals , Antibodies, Monoclonal/pharmacology , Antibodies, Monoclonal, Murine-Derived , Antigens, CD20/metabolism , Antilymphocyte Serum/pharmacology , B-Lymphocyte Subsets/drug effects , CD79 Antigens/metabolism , Humans , Immunoglobulins, Intravenous/pharmacology , Immunologic Factors/pharmacology , Plasma Cells/immunology , Plasma Cells/pathology , Plasmapheresis/methods , Rabbits , Retrospective Studies , Rituximab , Spleen/drug effects , Spleen/immunology , Syndecan-1/metabolism , Tumor Necrosis Factor Receptor Superfamily, Member 7/metabolismABSTRACT
From October 1985 to February 1992, we performed 80 percutaneous transluminal angioplasty procedures (PTA) in 76 patients with Coarctation of the Aorta (CoAo). Twenty eight patients (aged 2.6 to 62 years; mean, 11.4) underwent Magnetic Resonance Imaging (MRI) during the follow-up period, 2 to 60 months (m = 16) after dilation. Three of these patients were also studied before PTA. We found mild residual coarctation in 11, minimal irregularities in the aorta in five and excellent results in twelve cases. No aneurysms were found. In those patients that underwent MRI before the angioplasty was possible to choose the balloon, thus reducing the time during dilatation. In conclusion we believe that MRI is an excellent and well suited alternative for the serial studies in patients with CoAo, before PTA and in the follow-up.
Subject(s)
Angioplasty, Balloon/methods , Aortic Coarctation/diagnosis , Aortic Coarctation/therapy , Magnetic Resonance Imaging , Adolescent , Adult , Child , Child, Preschool , Follow-Up Studies , Humans , Middle AgedABSTRACT
A new vascular access for chronic hemodialysis is developed by creating a fistula in the upper arm between the end of the relocated basilic vein and anterior aspect of the brachial artery. The procedure has been used 24 times in 23 patients over the past 15 months (average eight months) with minimal complications and low failure rates. This fistula provides a straight, long, easily accessible conduit with high flows; it has only one vascular anastomosis and maintains the anatomic continuity of its venous end with the axillary vein. It also obviates the need for autologous, prosthetic, or heterografts. The procedure is indicated when suitable vessels in the forearm have been exhausted or are unavailable. However, additional clinical trials and continued long-term follow-up are necessary for more definite conclusions.
