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101. Trasplante hepático

Author

Herrero, J. I., Pardo, F., Quiroga, J., and Rotellar, F.

Subjects
Trasplante hepático, Hepatocarcinoma, Supervivencia, Survival, Hepatocellular carcinoma, Liver cirrhosis, Cirrosis hepática, Liver transplant
Abstract

El trasplante hepático es una opción terapéutica eficaz para las enfermedades hepáticas terminales. Las principales indicaciones del trasplante hepático son la cirrosis hepática, los tumores hepáticos (fundamentalmente, el hepatocarcinoma) y la insuficiencia hepática aguda grave. Con el paso de los años, las contraindicaciones absolutas para el trasplante se han ido reduciendo. La técnica quirúrgica también ha sufrido modificaciones. Los resultados del trasplante hepático han mejorado, de forma que la supervivencia al año del trasplante está próxima al 90% y a los cinco años, un 80% de los pacientes trasplantados siguen vivos. Liver transplantation is an efficient therapeutic option for terminal hepatic diseases. The principal indications of liver transplantation are hepatic cirrhosis, hepatic tumours (mainly, hepotocellular carcinoma) and acute liver failure. Over the years, the absolute contraindications for a transplant have lessened. Surgical techniques have also undergone changes. The results of liver transplant have improved so that survival one year after the transplant is close to 90% and after five years some 80% of transplanted patients continue to live.

Published
2006

102. IFN-alpha gene therapy for woodchuck hepatitis with adeno-associated virus: differences in duration of gene expression and antiviral activity using intraportal or intramuscular routes

Author

Berraondo, P. (Pedro), Ochoa, L. (Laura), Crettaz, J. (Julien), Rotellar, F. (Fernando), Vales, A. (África), Martinez-Anso, E. (Eduardo), Zaratiegui, M. (Mikel), Ruiz, J. (Juan), González-Aseguinolaza, G. (Gloria), and Prieto, J. (Jesús)

Subjects
Marmota/virology, viruses, Interferon-alpha/genetics, Dependovirus, Hepatitis B/therapy
Abstract

Gene delivery of IFN-alpha to the liver may represent an interesting strategy to maximize its antiviral efficacy and reduce side effects. We used a recombinant adeno-associated virus (AAV) encoding woodchuck IFN-alpha (AAV-IFN) to treat animals with chronic woodchuck hepatitis virus infection. The vector was given by intraportal or intramuscular route. Long-term transgene expression was detected after intraportal administration of an AAV encoding luciferase. In contrast, in the majority of the animals that received AAV-IFN through the portal vein, the expression of IFN-alpha was transient (30-40 days) and was associated with a significant but transient decrease in viral load. One animal, in which hepatic production of IFN-alpha persisted at high levels, died because of bone marrow toxicity. The disappearance of IFN-alpha expression correlated with the disappearance of AAV genomes from the liver. Intramuscular administration of AAV-IFN resulted in prolonged but fluctuating expression of the cytokine with no significant antiviral effect. In summary, this report shows that long-term expression of IFN-alpha in muscle is feasible but higher interferon levels might be needed to control viral replication. On the other hand, IFN-alpha gene delivery to the liver using an AAV vector induces a significant but transient antiviral effect in the woodchuck model.

Published
2005

105. A Retrospective Analysis of Oxaliplatin, Irinotecan and PK-Adjusted 5-Fluorouracil Within a Neoadjuvant Multidisciplinary Approach in Locally Advanced Pancreatic Cancer (LAPC) Patients

Author

Patricia, Martin Romano, primary, Aldaz, A., additional, Fusco, J.P., additional, Sola, J.J., additional, Chopitea, A., additional, Subtil, J.C., additional, Solorzano, J., additional, Pardo, F., additional, Arbea, L., additional, Garzon, C., additional, Rotellar, F., additional, Zufia, L., additional, and Rodriguez, J., additional

Published
2014
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107. Reduced hepatic aquaporin-9 and glycerol permeability are related to insulin resistance in non-alcoholic fatty liver disease

Author

Rodríguez, A, primary, Gena, P, additional, Méndez-Giménez, L, additional, Rosito, A, additional, Valentí, V, additional, Rotellar, F, additional, Sola, I, additional, Moncada, R, additional, Silva, C, additional, Svelto, M, additional, Salvador, J, additional, Calamita, G, additional, and Frühbeck, G, additional

Published
2013
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109. Papel de la cirugía en el tratamiento del linfoma gástrico primario

Author

Baixauli, J. (Jorge), Hernandez-Lizoain, J.L. (Jose Luis), Panizo, A. (Ángel), Espi, A. (A.), Rotellar, F. (Fernando), Rodriguez-Spiteri, N. (Natalia), Olea, J. (J.), Martinez-Regueira, F. (Fernando), Diez-Caballero, A. (Alberto), Pardo, F. (Fernando), and Álvarez-Cienfuegos, J. (Javier)

Subjects
Linfoma Gastrointestinal, Radioterapia, Cirugía, Linfoma Gástrico, Quimioterapia
Abstract

El Linfoma Gástrico Primario es una entidad patológica cuyo manejo óptimo está en discusión. Se estudian retrospectivamente 23 pacientes tratados en nuestro Centro por Linfoma Gástrico entre 1976 y 1998 con resección quirúrgica como terapia principal. En diez pacientes la cirugía fue el único tratamiento realizado, en el resto se asoció quimio y/o radioterapia según criterio del oncólogo hematólogo responsable. No hubo diferencias en cuanto a morbimortalidad entre los diferentes tratamientos. Se analizan las características clínicas e histológicas y la evolución de los pacientes. Ninguno de los pacientes ha fallecido a consecuencia del linfoma, no habiéndose presentado tampoco ningún caso de recurrencia local ni a distancia. Opinamos que la cirugía es una opción válida en el tratamiento del Linfoma Gástrico Primario. La asociación de tratamientos complementarios dependerá del estadio definitivo, las características histológicas del tumor y la posibilidad de realizar o no una resección radical.

Published
2000

116. Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity

Author

Gómez-Ambrosi, J, primary, Silva, C, additional, Galofré, J C, additional, Escalada, J, additional, Santos, S, additional, Millán, D, additional, Vila, N, additional, Ibañez, P, additional, Gil, M J, additional, Valentí, V, additional, Rotellar, F, additional, Ramírez, B, additional, Salvador, J, additional, and Frühbeck, G, additional

Published
2011
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124. 3564 POSTER Histological response as potential prognostic factor after neoadjuvant chemotherapy (Ch) and chemoradiotherapy (CRT) for locally-advanced pancreatic cancer: preliminary results

Author

Chopitea, A., primary, Diaz-Gonzalez, J.A., additional, Rodriguez, J., additional, Pardo, F., additional, Arbea, L., additional, Viudez, A., additional, Aristu, J.J., additional, Rotellar, F., additional, Montiel, C., additional, and Garcia-Foncillas, J., additional

Published
2007
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127. Cirugía laparoscópica biliar

Author

Martí-Cruchaga, P., primary, Valentí, V., additional, Pastor, C., additional, Poveda, I., additional, Zozaya, G., additional, and Rotellar, F., additional

Published
2005
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135. Angiomiolipoma epitelioide hepático

Author

Gil, A., primary, Toledo, G., additional, Rotellar, F., additional, -Spiteri, N.R., additional, Olea, J., additional, Cervera, M., additional, Pardo, F., additional, Sola, J., additional, and Álvarez Cienfuegos, J., additional

Published
2002
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138. The L-α-lysophosphatidylinositol/GPR55 system and its potential role in human obesity.

Author

Moreno-Navarrete JM, Catalán V, Whyte L, Díaz-Arteaga A, Vázquez-Martínez R, Rotellar F, Guzmán R, Gómez-Ambrosi J, Pulido MR, Russell WR, Imbernón M, Ross RA, Malagón MM, Dieguez C, Fernández-Real JM, Frühbeck G, Nogueiras R, Moreno-Navarrete, José María, Catalán, Victoria, and Whyte, Lauren

Abstract

GPR55 is a putative cannabinoid receptor, and l-α-lysophosphatidylinositol (LPI) is its only known endogenous ligand. We investigated 1) whether GPR55 is expressed in fat and liver; 2) the correlation of both GPR55 and LPI with several metabolic parameters; and 3) the actions of LPI on human adipocytes. We analyzed CB1, CB2, and GPR55 gene expression and circulating LPI levels in two independent cohorts of obese and lean subjects, with both normal or impaired glucose tolerance and type 2 diabetes. Ex vivo experiments were used to measure intracellular calcium and lipid accumulation. GPR55 levels were augmented in the adipose tissue of obese subjects and further so in obese patients with type 2 diabetes when compared with nonobese subjects. Visceral adipose tissue GPR55 correlated positively with weight, BMI, and percent fat mass, particularly in women. Hepatic GPR55 gene expression was similar in obese and type 2 diabetic subjects. Circulating LPI levels were increased in obese patients and correlated with fat percentage and BMI in women. LPI increased the expression of lipogenic genes in visceral adipose tissue explants and intracellular calcium in differentiated visceral adipocytes. These findings indicate that the LPI/GPR55 system is positively associated with obesity in humans. [ABSTRACT FROM AUTHOR]

Published
2012
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139. Association of increased Visfatin/PBEF/NAMPT circulating concentrations and gene expression levels in peripheral blood cells with lipid metabolism and fatty liver in human morbid obesity.

Author

Catalán, V., Gómez-Ambrosi, J., Rodríguez, A., Ramírez, B., Silva, C., Rotellar, F., Cienfuegos, J.A., Salvador, J., and Frühbeck, G.

Abstract

Abstract: Background and aims: Nicotinamide phosphoribosyltransferase (NAMPT) is an adipokine with physiological effects on the control of glucose homeostasis as well as potentially involved in inflammation. The association of circulating NAMPT concentrations with obesity has not been clearly established. The aim of the present work was to evaluate the effect of obesity on circulating concentrations and gene expression levels of NAMPT in human peripheral blood cells (PBCs) as well as its involvement in inflammation, glucose and lipid metabolism. Methods and results: Forty-four serum samples obtained from 14 lean and 30 obese volunteers were used to analyse the circulating concentrations of NAMPT. In addition, PBC, omental adipose tissue (OM) and liver biopsy samples obtained from a subgroup of subjects were used to determine transcript levels of NAMPT by Real-time PCR. Glucose and lipid profile as well as several inflammatory factors and hepatic enzymes were analysed. NAMPT circulating concentrations (P <0.01) and gene expression levels in PBC (P <0.05) were significantly increased in obese patients as compared to lean subjects. Total-cholesterol (P =0.016), HDL-cholesterol (P =0.036) and triglycerides (P =0.050) were significant and independent determinants of circulating concentrations of NAMPT (P <0.01). Moreover, a positive correlation (P <0.01) was found with the hepatic enzymes alanine aminotransferase, aspartate aminotransferase, and γ-glutamyltransferase after BMI adjustment. Conclusion: Our work shows that NAMPT circulating concentrations and mRNA expression levels in PBC are increased in obese patients and that plasma NAMPT levels are related to inflammation, lipid metabolism and hepatic enzymes suggesting a potential involvement in fatty liver disease and in the obesity-associated inflammatory state. [Copyright &y& Elsevier]

Published
2011
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140. Full laparoscopic vascular reconstruction for portal tumoral invasion during a right hepatectomy using the caudal approach

Author

Rotellar, F. (Fernando)

Subjects
Laparoscopic vascular reconstruction, Portal tumoral invasion, Right hepatectomy, Caudal approach
Abstract

Background: Laparoscopic liver surgery has progressively evolved. Consequently, liver procedures are increasingly performed laparoscopically, particularly in experienced centers. However, vascular resection and reconstruction still are considered a limitation for laparoscopy1 due to the risk of bleeding and the technical difficulty. Methods: A 72-year-old woman with a history of colorectal cancer had a 10 cm metastasis diagnosed in the right hemiliver with tumoral invasion of the right portal branch and tumor thrombus advancing to the portal confluence. After adjuvant chemotherapy and with stable disease, surgical resection was planned.2,3 Tips to avoid portal stenosis were carefully followed. Results: The operation was performed with a fully laparoscopic procedure. To minimize manipulation, an in situ right hepatectomy was performed.4 The right hepatic artery was dissected and ligated. The liver transection was guided with a caudal approach of the middle hepatic vein.5 The right biliary duct was then divided, achieving an excellent exposure of the portal bifurcation. The main and left portal trunks were occluded with vascular clamps, and the right portal vein was sharply divided with scissors. The stump was sutured to minimize backflow bleeding and to cover the tumor thrombus. Then, the portal opening was transversally sutured with a 5/0 running suture. The clamps were released, and the authors observed no bleeding and an adequate caliber with no stenosis. The procedure was completed in the standard fashion. The postoperative course was uneventful, and the woman was discharged on postoperative day 3. No early or late complications were observed.6 CONCLUSIONS: In selected cases, patients who require vascular resection and reconstruction during hepatectomies can benefit from the advantages of a laparoscopic approach.

Published
2022

149. Portal Revascularization in the Setting of Cavernous Transformation Through a Paracholedocal Vein: A Case Report

Author

Rotellar, F. (Fernando)

Subjects
Portal Vein/surgery, Thrombosis/surgery, Vascular Surgical Procedures
Abstract

Diffuse thrombosis of the entire portal system (PVT) and cavernomatous transformation of the portal vein (CTPV) represents a demanding challenge in liver transplantation. We present the case of a patient with nodular regenerative hyperplasia and recurrent episodes of type B hepatic encephalopathy concomitant with PVT as well as CTPV, successfully treated with orthotopic liver transplantation. The portal inflow to the graft was carried out through the confluence of 2 thin paracholedochal varicose veins, obtaining good early graft function and recovery of the encephalopatic episodes. This alternative should be kept in mind as an option to assure hepatopetal splanchnic flow in those cases of diffuse thrombosis and cavernomatous transformation of portal vein. CI - Copyright (c) 2010 Elsevier Inc. All rights reserved.

Published
2010

150. Totally Laparoscopic Roux-en-Y Duct-to-Mucosa Pancreaticojejunostomy After Middle Pancreatectomy A Consecutive Nine-case Series at a Single Institution

Author

Rotellar, F. (Fernando)

Subjects
Anastomosis, Roux-en-Y, Pancreatectomy/methods, Pancreatic Neoplasms/diagnosis/surgery
Abstract

To present the results of a series of laparoscopic middle pancreatectomies with roux-en-Y duct-to-mucosa pancreaticojejunostomy. SUMMARY OF BACKGROUND DATA: Middle pancreatectomy makes it possible to preserve pancreatic parenchyma in the resection of lesions that traditionally have been treated by distal splenopancreatectomy or cephalic duodenopancreatectomy. The laparoscopic approach could minimize the invasiveness of the procedure and enhance the benefits of middle pancreatectomy. METHODS: From March 2005 to October 2007, 9 consecutive patients with benign or low malignant potential lesions in the pancreatic neck or body underwent surgery. Laparoscopic middle pancreatectomy with a roux-en-Y duct-to-mucosa pancreaticojejunostomy was planned on all of them. In the first 2 patients, the pancreas was transected by endostapler; in the last 7, the staple line was reinforced with absorbable polymer membrane. RESULTS: The intervention was concluded laparoscopically in every case except 1 (laparoscopic-assisted) in which pancreaticojejunostomy was performed by means of minilaparotomy. Mortality was 0% and perioperative morbidity was 33%, (fistula of the cephalic stump in the first 2 patients (22%)). The pancreaticojejunostomy fistula rate was 0%. The median postoperative hospital stay was 5 days (range, 3-41). In the last 7 patients, in which pancreas was transected with staple line reinforcement material there were no stump fistulas; morbidity decreased to 14% and the median hospital stay was 4 days (range, 3-30). CONCLUSIONS: Laparoscopic middle pancreatectomy is feasible and safe. Duct-to-mucosa pancreaticojejunostomy can be performed safely using this approach. The method of pancreatic transection seems to be decisive in the incidence of cephalic stump fistulas.

Published
2008

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