Browsing by Author "Martinez, Jorge"

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    ADULT-TO-PEDIATRIC LIVING DONOR LIVER TRANSPLANT IN RECIPIENTS >20 KG: A CASE SERIES OF FULL LEFT LOBE GRAFTS
    (2024) Ortiz, Catalina; Meira-Jr, Jose Donizeti; Pattillo, Juan Carlos; Vinuela, Eduardo; Jarufe, Nicholas; Martinez, Jorge; Briceno, Eduardo; Dib, Martin
    BACKGROUND: Chile presents one of the lowest organ donation rates, resulting in pediatric Walter de Biase 1 , Claudemiro 1 , Eduardo Gu liver waitlist mortality rates up to 38.1%. Live donor liver transplantation is one of the main alternatives Fabricio Ferreira 3 ,Paulo 3 to decrease waitlist mortality, mostly utilized in our country for small children up to 20 kg. AIMS: The aim of this study was to report a three-case series of adult-to-pediatric living donor liver transplantation using a full left lobe graft. METHODS: We report three cases of children with more than 20 kg who received complete left hemi-grafts in different clinical scenarios. The indications and techniques- Racional: O tratamento de escolha para pacientes com hipertens & atilde;o portal adopted are discussed. RESULTS: Three children, two girls and one boy, aged 11, 7, and 3 years, esquistossom & oacute;tica com sangramento de varizes h a desconex & atilde;o & aacute;zigo-portal mais were transplanted. The indications for transplant were fulminant hepatitis of autoimmune etiology, esplenectomia (DAPE) associada & agrave; terapia endosc & oacute;pica. Porhm, estudos mostram aumento hepatoblastoma, and chronic liver failure due to autoimmune hepatitis, respectively. The evolution was satisfactory in all three children, and to date, all are well, approximately 12-24 months after the do calibre das varizes em alguns pacientes durante o seguimento em longo prazo. Objetivo: transplant. CONCLUSIONS: The use of a living donor left lateral segment (segments 2 and 3) has been Avaliar oimpactodaDAPE e tratamento endosc & oacute;picop & oacute;s-operat & oacute;rionocomportamento successfully employed in pediatric liver transplantation. However, it is only suitable for infants and lowdas varizes esof & aacute;gicas e recidiva hemorr & aacute;gica, de pacientes esquistossom & oacute;ticos. Mhtodos: weight children. This approach using the whole left hemi-liver graft contributes to the reduction of Foram estudados 36 com a cinco distribu & iacute;dos em small-for-size syndrome, mortality rate, and waiting times associated with deceased donors.
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    Cervical metastases of glucagonoma in a patient with multiple endocrine neoplasia type 1: Report of a case
    (2008) Butte, Jean M.; Montero, Pablo H.; Solar, Antonieta; Torres, Javiera; Olmos, Pablo R.; Goni, Ignacio; Quintana, Juan C.; Martinez, Jorge; Llanos, Osvaldo
    Multiple endocrine neoplasia type 1 (MEN 1) is a syndrome characterized by tumors of the parathyroid glands, pancreatic islet cells, duodenum, and pituitary gland. We report a case of cervical metastases of glucagonoma with MEN 1. The patient was a 34-year-old woman admitted to our hospital with epigastric pain. Her medical history included two resections of prolactinoma and two upper GI hemorrhages secondary to duodenal ulcers. Computed tomography (CT) showed two hypervascular lesions in the tail of the pancreas and cervical ultrasound showed multiple hypoechogenic ovoid images in the neck. A cervical CT scan confirmed two 15-mm lymph nodes in the left cervical region and 111In-DOTATOC imaging showed focal abnormal somatostatin expression in the pancreatic tail and the cervical nodes. The patient had asymptomatic hypoglycemic episodes, with blood sugar levels as low as 30 mg/dl, which raised our suspicion of MEN 1 associated with pancreatic insulinoma. Thus, we performed a distal pancreatectomy with bilateral cervical dissection and parathyroid gland resection. Histopathological examination revealed 12 pancreatic tumors as well as metastases in four cervical lymph nodes. The resected parathyroid glands had normal structure, suggesting parathyroid hyperplasia. A follow-up CT scan, 18 months after surgery, showed new tumors in the head of the pancreas and in the duodenal wall. A pancreatoduodenectomy was performed and histopathological examination revealed nine nonfunctioning endocrine tumors in the pancreas, one tumor in the duodenal wall, and metastases in two peripancreatic lymph nodes. The patient recovered well and remains asymptomatic.
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    FOXO1 regulates wound-healing responses in human gingival fibroblasts
    (2024) Rojas, Leticia; Tobar, Nicolas; Espinoza, Javier; Rios, Susana; Martinez, Constanza; Martinez, Jorge; Graves, Dana T.; Smith, Patricio C.
    Background and objective: Forkhead box-O 1 (FOXO1) is a transcription factor actively involved in oral wound healing at the epithelial barrier. However, less is known regarding the role of FOXO1 during the tissue repair response in the connective tissue compartment. This study explored the involvement of FOXO1 in the modulation of fibroblast activity related to wound healing. Methods: Primary cultures of human gingival fibroblasts were obtained from four healthy young donors. Myofibroblastic differentiation, collagen gel contraction, cell migration, cell spreading, and integrin activation were evaluated in the presence or absence of a FOXO1 inhibitor (AS1842856). Variations in mRNA and proteins of interest were evaluated through qRT-PCR and western blot, respectively. Distribution of actin, alpha-smooth muscle actin, and beta 1 integrin was evaluated using immunofluorescence. FOXO1 and TGF-beta 1 expression in gingival wound healing was assessed by immunohistochemistry in gingival wounds performed in C57BL/6 mice. Images were analyzed using ImageJ/Fiji. ANOVA or Kruskal-Wallis test followed by Tukey's or Dunn's post-hoc test was performed. All data are expressed as mean +/- SD. p < .05 was considered statistically significant. Results: FOXO1 inhibition caused a decrease in the expression of the myofibroblastic marker alpha-SMA along with a reduction in fibronectin, type I collagen, TGF-beta 1, and beta 1 integrin mRNA level. The FOXO1 inhibitor also caused decreases in cell migration, cell spreading, collagen gel contraction, and beta 1 integrin activation. FOXO1 and TGF-beta 1 were prominently expressed in gingival wounds in fibroblastic cells located at the wound bed. Conclusion: The present study indicates that FOXO1 plays an important role in the modulation of several wound-healing functions in gingival fibroblast. Moreover, our findings reveal an important regulatory role for FOXO1 on the differentiation of gingival myofibroblasts, the regulation of cell migration, and collagen contraction, all these functions being critical during tissue repair and fibrosis.
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    Laparoscopic Versus Open Distal Pancreatectomy: Comparative Analysis of Clinical Outcomes at a Single Institution
    (2018) Jarufe, Nicolas; Soto, Pedro; Ahumada, Vanessa; Pacheco, Sergio; Salinas, Jose; Galindo, Jose; Bachler, Jean-Phillipe; Achurra, Pablo; Rebolledo, Rolando; Guerra, Juan F.; Briceno, Eduardo; Martinez, Jorge
    Purpose:Undertake a comparison between laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for the management of benign and malignant lesions.Methods:A case series study of 93 consecutive patients subjected to a distal pancreatectomy for pancreatic tumors between 2001 and 2015. In each patient, clinical and surgical characteristic, postoperative course, histopathologic examination, and survival were analyzed.Results:LDP was associated with significantly less operative blood loss (50mL vs. 300mL; P<0.01), higher spleen preservation rate (52.6% vs. 19.2%; P<0.01) and shorter hospital stay (5d vs. 8d; P<0.01). In patients with adenocarcinoma, survival at 1 and 5 years were 63.5% and 15.9% in the ODP group versus 66.7% and 33.3% in the LDP group (P=0.43).Conclusions:LDP is a safe and feasible procedure for DP resections. LDP offers advantages over ODP in terms of reduction of operative blood loss, higher spleen preservation rate, and shorter hospital stay.
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    Operational tolerance after liver transplantation, more common than we think: A case report
    (MEXICAN ASSOC HEPATOLOGY, 2011) Benitez, Carlos; Pablo Arancibia, Juan; Arrese, Marco; Soza, Alejandro; Dominguez, Pilar; Jarufe, Nicolas; Martinez, Jorge; Maria Perez Ayuso, Rosa
    Operational tolerance after liver transplantation has been described in around 20% of the recipients. These patients are able to maintain a normal graft function in the absence of immunosuppressive drugs, thus being free of adverse effects that are common and frequently severe. Here we present a well-documented case of operational tolerance after liver transplantation and discuss current concepts on this topic with emphasis on recent findings that will potentially allow for identifying graft-tolerant patients.
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    Portosystemic shunt surgery for severe portal hypertension due to portal thrombosis after bariatric surgery
    (2024) Reyes, Natalia; Jarufe, Alessandra; Briceno, Eduardo; Vinuela, Eduardo; Martinez, Jorge; Dib, Martin; Jarufe, Nicolas
    Portal vein thrombosis is a rare complication after laparoscopic sleeve gastrectomy, a widely performed bariatric surgery procedure. Occasionally, the development of portal vein thrombosis can progress to more severe conditions, including portal hypertension and cavernomatosis, thereby presenting a complex and challenging clinical scenario. The management of such complications often requires careful consideration; however, surgical intervention in the form of a splenorenal shunt is an exceptional indication. We present the case of a 33-year-old female patient who had previously undergone laparoscopic sleeve gastrectomy in 2014 and subsequently developed portal thrombosis, followed by cavernomatosis and associated complications of portal hypertension. A proximal splenorenal shunt procedure and splenectomy were successfully performed to manage portal hypertension. The presentation of this clinical case aims to contribute to the available evidence and knowledge surrounding this rare and challenging pathology.
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    Right Lobe Liver Donation After Bariatric Surgery. A Case Series of 4 Living Donors
    (2022) Garcia, Daniel; Riveros, Sergio; Ochoa, Gabriela; Rebolledo, Patricia; Achurra, Pablo; Briceno, Eduardo; Vinuela, Eduardo; Arab, Juan Pablo; Jarufe, Nicolas; Fernandes, Eduardo; Martinez, Jorge; Dib, Martin
    Background. The increasing prevalence of obesity and need for bariatric surgery as well as the expanding use of living donors for liver transplantation means that potential donors could present with this surgical history. We present 4 cases of liver donors with previous bariatric surgery in our living donor liver transplant program. Methods. A retrospective descriptive analysis of patients with a bariatric surgery history who underwent right hepatectomy in our living donor liver transplant program is presented. Results. Case 1: A 53-year-old man with body mass index (BMI) of 33 who underwent lapa-roscopic sleeve gastrectomy (LSG). Pretransplant BMI was 21.5. Case 2: A 46-year-old woman with a BMI maximum of 40.8 who underwent LSG and required conversion to Roux-en-Y gas-tric bypass. Pretransplant BMI was 35.1. Case 3: A 53-year-old woman with a BMI maximum of 31.6 who underwent LSG. Pretransplant BMI was 24.2. Case 4: A 38-year-old man with a BMI maximum of 41.5 who underwent Roux-en-Y gastric bypass 6 years before the hepatectomy. Pretransplant BMI was 29.4. No complications were observed. Average operative time was 367.5 minutes, with a hospital stay of 5.8 days and 100% graft survival to date. Discussion. Utilization of selected donors with previous bariatric surgery appears to be a safe option and increases the donor pool.
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    Risk factors for readmission after a cholecystectomy: a case-control study
    (2024) Garcia, Daniel; Pastore, Antonia; Rodriguez, Javier; Crovari, Fernando; Cerda, Jaime; Rebolledo, Patricia; Achurra, Pablo; Vinuela, Eduardo; Martinez, Jorge; Dib, Martin; Briceno, Eduardo
    Objective: The aim of this study was to assess the risk factors associated with 30 -day hospital readmissions after a cholecystectomy. Methods: We conducted a case-control study, with data obtained from UC-Christus from Santiago, Chile. All patients who underwent a cholecystectomy between January 2015 and December 2019 were included in the study. We identified all patients readmitted after a cholecystectomy and compared them with a randomized control group. Univariate and multivariate analyses were conducted to identify risk factors. Results: Of the 4866 cholecystectomies performed between 2015 and 2019, 79 patients presented 30 -day hospital readmission after the surgical procedure (1.6%). We identified as risk factors for readmission in the univariate analysis the presence of a solid tumor at the moment of cholecystectomy (OR = 7.58), high pre -operative direct bilirubin (OR = 2.52), high pre -operative alkaline phosphatase (OR = 3.25), emergency admission (OR = 2.04), choledocholithiasis on admission (OR = 4.34), additional surgical procedure during the cholecystectomy (OR = 4.12), and post -operative complications. In the multivariate analysis, the performance of an additional surgical procedure during cholecystectomy was statistically significant (OR = 4.24). Conclusion: Performing an additional surgical procedure during cholecystectomy was identified as a risk factor associated with 30 -day hospital readmission.
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    Sleeve gastrectomy as obesity after orthotopic treatment for severe liver transplantation
    (2007) Butte, Jean M.; Devaud, Nicolas; Jarufe, Nicolas P.; Boza, Camilo; Perez, Gustavo; Torres, Javiera; Perez-Ayuso, Rosa M.; Arrese, Marco; Martinez, Jorge
    Obesity is highly prevalent in both liver transplant candidates and recipients, and can have a significant impact on perioperative morbidity and mortality and the overall cost of transplantation. Herein, we describe an obese patient who was managed sequentially with an intragastric balloon in the pre-transplant setting and a gastric sleeve following transplantation, with good long-term results. Sleeve gastrectomy is a non-malabsorptive bariatric procedure with potential benefit for liver transplant patients due to its lack of influence on the absorption of immunosuppressive agents.
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    Status of the neuromyelitis optica spectrum disorder in Latin America
    (ELSEVIER SCI LTD, 2021) Rivera, Victor M.; Hamuy, Fernando; Rivas, Veronica; Gracia, Fernando; Ignacio Rojas, Juan; Bichuetti, Denis Bernardi; Maria Villa, Andres; Marques, Vanessa Daccah; Soto, Arnoldo; Bertado, Brenda; Trevino Frenk, Irene; Galleguillos, Lorna; Quinones, Jairo; Ramirez, Deyanira A.; Caparo Zamalloa, Cesar; Ciampi Diaz Ethel Leslie; Lana Peixoto, Marco A.; Rodriguez, Emmanuel; Zarco, Luis; Sinay, Vladimiro; Armas, Elizabeth; Becker, Jefferson; Benzadon, Aron; Lopez, Ericka; Carnero Contentti, Edgar; Patricio Correa Diaz, Edgar; Diaz, Alejandro; Veronica Fleitas, Cynthia; Playas, Gil; Molina, Omaira; Rojas, Edgard; Sato, Douglas; Soto, Ibis; Vasquez Cespedes, Johana; Correale, Jorge; Barboza, Andres; Monterrey, Priscilla; Candelario, Awilda; Tavolini, Dario R.; Parajeles, Alexander; Pujol, Biany Santos; Diaz de la Fe, Amado; Alonso, Ricardo; Bolana, Carlos; Kagi Guzman, Marianne; Carra, Adriana; Gonzalez Gamarra, Oscar; Vera Raggio, Jose; Cesar Rodriguez, Luis; Eunice Ramirez, Nicia; Ordonez, Laura; Skromne, Eli; Lbeth Portillo, Ligia; Perez Canabal, Alfredo; Weiser, Roberto; Sirias, Vanessa; Fernandez Calderon, Ramiro; Arturo Cornejo, Ernesto; Hernandez, Marianella; Duran Quiroz, Juan Carlos; Alberto Garcia, Luis; Oviedo Cedeno, Carlos; Martinez, Jorge; Abad Herrera, Patricio
    Background: Neuromyelitis optica spectrum disorders (NMOSD) is an increasing diagnostic and therapeutic challenge in Latin America (LATAM). Despite the heterogeneity of this population, ethnic and socioeconomic commonalities exist, and epidemiologic studies from the region have had a limited geographic and population outreach. Identification of some aspects from the entire region are lacking.
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    Steatotic livers. Can we use them in OLTX? Outcome data from a prospective baseline liver biopsy study
    (MEXICAN ASSOC HEPATOLOGY, 2012) Gabriel, Mauricio; Moisan, Fabrizio; Vidal, Marcela; Duarte, Ignacio; Jimenez, Macarena; Izquierdo, Guillermo; Dominguez, Pilar; Mendez, Javier; Soza, Alejandro; Benitez, Carlos; Perez, Rosa; Arrese, Marco; Guerra, Juan; Jarufe, Nicolas; Martinez, Jorge
    Introduction. Steatotic livers have been associated with greater risk of allograft dysfunction in liver transplantation. Our aim was to determinate the prevalence of steatosis in grafts from deceased donors in Chile and to assess the utility of a protocol-bench biopsy as an outcome predictor of steatotic grafts in our transplant program. Material and methods. We prospectively performed protocol-bench graft biopsies from March 2004 to January 2009. Biopsies were analyzed and classified by two independent pathologists. Steatosis severity was graded as normal from absent to < 6%; grade 1: 6-33%; grade 2: > 33-66% and grade 3: > 66%. Results. We analyzed 58 liver grafts from deceased donors. Twenty-nine grafts (50%) were steatotic; 9 of them (16%) with grade 3. Donor age (p < 0.001) and BMI over 25 kg/m(2) (p = 0.012) were significantly associated with the presence of steatosis. There were two primary non-functions (PNF); both in a grade 3 steatotic graft. The 3-year overall survival was lower among recipients with macrovesicular steatotic graft (57%) than recipients with microvesicular (85%) or non-steatotic grafts (95%) (p = 0.026). Conclusion. Macrovesicular steatosis was associated with a poor outcome in this series. A protocol bench-biopsy would be useful to identify these grafts.
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    Successful treatment of severe hepatopulmonary syndrome with a sequential use of TIPS placement and liver transplantation
    (2009) Benitez, Carlos; Arrese, Marco; Jorquera, Jorge; Godoy, Ivan; Contreras, Andrea; Loyola, Soledad; Pilar Dominguez, P.; Jarufe, Nicolas; Martinez, Jorge; Perez-Ayuso, Rosa Maria
    Hepatopulmonary syndrome (HPS) is a complication of portal hypertension (PH) defined by the presence of liver disease, abnormal pulmonary gas exchange and evidence of intrapulmonary vascular dilatations (IPVD) producing a right to left intrapulmonary shunt. Liver transplantation (LT) is the treatment of choice; however, severe hypoxemia may contraindicate LT. The use of transjugular intrahepatic portosystemic shunts (TIPS) could be effective in HPS, although available data is limited. Aim: To report a clinical case of severe HPS treated sequentially with TIPS and LT. Case report: A 46 year old female cirrhotic patient presented with rapidly progressive dyspnea, hypoxemia (PaO2 60 mmHg, SaO(2) 92%) and increased alveolar-arterial oxygen gradient (A-a) (46 mmHg). She also had orthodeoxia (SaO(2) 87% in sitting position, but 91% in a prone position). A CT scan and pulmonary angiography were normal. Spirometric assessment showed a mild restrictive pattern and a desaturation was observed in a six-minute walking test. Contrast-enhanced echocardiography (CEE) showed intrapulmonary shunting. A HPS was diagnosed and liver transplantation was disregarded due to severe hypoxemia. The patient underwent TIPS placement. After four weeks, a significant improvement of dyspnea and a complete remission of orthodeoxia were seen. One year later, the patient was successfully transplanted. Interestingly, six months after LT, and in the absence of dyspnea, a new CEE showed persistent passing of bubbles to the left cavities. Comments/Conclusion: Persistent right-to-left shunt after TIPS placement and liver transplantation in spite of the improvement of pulmonary function tests suggests long-term persistence of structural changes in the pulmonary vascular tree after liver transplantation. Because of lack of data, it is not possible to recommend the routine use of TIPS as a part of the conventional management of HPS. However, in patients with severe hypoxemia TIPS placement can reasonably be used as a bridge towards transplantation.
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    Thalidomide for the treatment of metastatic hepatic epithelioid hemangioendothelioma: A case report with a long term follow-up
    (ELSEVIER ESPANA, 2011) Salech, Felipe; Valderrama, Sebastian; Nervi, Bruno; Carlos Rodriguez, Juan; Oksenberg, Danny; Koch, Alvaro; Smok, Gladys; Duarte, Ignacio; Maria Perez Ayuso, Rosa; Jarufe, Nicolas; Martinez, Jorge; Soza, Alejandro; Arrese, Marco; Riquelme, Arnoldo
    Hepatic epithelioid hemangioendothelioma (HEH) is an unusual, low-grade malignant vascular tumor of the liver. Here we describe a case of a 40-year-old woman who presented with abdominal pain in the upper right quadrant and giant hepatomegaly, in which imaging studies and a fine-needle liver biopsy confirmed the presence of a large EHE with an isolated lung metastasis. After balancing all possible therapeutic modalities the patient was treated conservatively with thalidomide (300 mg/day). The drug was well tolerated with minimal toxicity and the patient continues on therapy 109 months after treatment was started with no disease progression. Current therapeutic options for HEH are discussed in light of the clinical case with particular emphasis on anti-angiogenic therapies.
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    Trasplante hepático: Evolución, curva de aprendizaje y resultados después de los primeros 300 casos
    (2019) Francisco Guerra, Juan; Luis Quezada, Jose; Cancino, Alejandra; Arrese, Marco; Wolff, Rodrigo; Benitez, Carlos; Carlos Pattillo, Juan; Cristobal Gana, Juan; Concha, Mario; Cortinez, Luis; Vera, Magdalena; Miranda, Paula; Rubilar, Francisco; Troncoso, Andres; Briceno, Eduardo; Dib, Martin; Jarufe, Nicolas; Martinez, Jorge
    Background: Liver transplantation (LT) is an option for people with liver failure who cannot be cured with other therapies and for some people with liver cancer. Aim: To describe, and analyze the first 300 LT clinical results, and to establish our learning curve. Material and Methods: Retrospective cohort study with data obtained from a prospectively collected LT Program database. We included all LT performed at a single center from March 1994 to September 2017. The database gathered demographics, diagnosis, indications for LT, surgical aspects and postoperative courses. We constructed a cumulative summation test for learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30 days, and actuarial 1-, and 5-year survival rate were analyzed. Results: A total of 281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percent of patients were younger than 18 years old. The first, second and third indications for LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis and alcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in 51 cases (17%). The overall complication rate was 71%. Infectious and biliary complications were the most common of them (47 and 31% respectively). The LC-CUSUM curve shows that the first 30 patients corresponded to the learning curve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rates were 82 and 71.4%, respectively. Conclusions: Outcome improvement of a LT program depends on the accumulation of experience after the first 30 transplants and the peri-operative mortality directly impacted long-term survival.
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    Type I choledochal cyst. Total laparoscopic resection and Roux-en-Y reconstruction to two separated ducts
    (2024) Reyes, Natalia; Sotomayor, Camila; Inzunza, Martin; Briceno, Eduardo; Vinuela, Eduardo; Martinez, Jorge; Jarufe, Nicolas
    A choledochal cyst is a rare condition that requires surgical treatment to prevent complications, such as obstructive jaundice, cyst rupture, cholangitis, and the risk of malignancy. Complete cyst excision is considered the best option, as it reduces the risk of inflammation and the development of cholangiocarcinoma. Therefore, cholecystectomy and complete cyst resection followed by reconstruction with a Roux-en-Y hepaticojejunostomy is the treatment of choice. We present a case (with video) that shows the complete resection of a type I choledochal cyst with Roux-en-Y reconstruction of two separate ducts since the right posterior duct reached the cyst independently. The laparoscopic approach offers all the advantages of mini-invasive surgery and better visualization of the structures; however, biliary reconstruction to fine ducts implies a surgical challenge that requires high training in mini-invasive surgery.