Luis Grande

Publications (236) View all

• Article: Primary lymphoma of the colon.

  M Pascual, B Sánchez-González, M García, M Pera, L Grande
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  ABSTRACT: Background: primary colorectal lymphoma is a very rare disease, representing less than 0.5 % of all primary colorectal neoplasms. The gastrointestinal tract is the most frequently involved site of all extranodal lymphomas, the most common type of that is non-Hodgkin s lymphoma. Early diagnosis is often difficult because of unspecific symptoms. Therapeutic approaches have classically included radical resection, chemotherapy and radiotherapy.Materials and methods: we present our experience in the management of primary colorectal lymphomas over a 17-year period (1994-20011).Results: in this period 7 cases of primary colorectal lymphoma were diagnosed in our institution. Abdominal pain and change in bowel habit were the most frequent symptoms. Five patients underwent emergency surgery because of bleeding or bowel obstruction. All primary intestinal lymphomas studied were of the Bcell phenotype. Patients were followed up for a median of 59 months (range 1-180). Three of them are alive with no evidence of recurrence.Conclusion: combination treatment with chemotherapy and surgery can obtain good remission rate. Surgery can resolve complications such bleeding or intestinal perforation that are implicated in lymphoma mortality.
  Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 02/2013; 105(2):74-78. · 1.55 Impact Factor
• Article: Laparoscopic Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy as a Definitive Surgical Procedure for Morbid Obesity. Mid-Term Results.

  Pablo Vidal, José M Ramón, Albert Goday, David Benaiges, Lourdes Trillo, Alejandra Parri, Susana González, Manuel Pera, Luís Grande
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  ABSTRACT: BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been gaining acceptance because it has shown good short- and mid-term results as a single procedure for morbid obesity. The aim of this study was to compare short- and mid-term results between laparoscopic Roux-en-Y gastric bypass (LRYGB) and LSG. METHODS: Observational retrospective study from a prospective database of patients undergoing LRYGB and LSG between 2004 and 2011, where 249 patients (mean age 44.7 years) were included. Patients were followed at 1, 3, 6, 12, and 18 months, and annually thereafter. Short- and mid-term weight loss, comorbidity improvement or resolution, postoperative complications, re-interventions, and mortality were evaluated. RESULTS: One hundred thirty-five LRYGB and 114 LSG were included. Significant statistical differences between LRYGB and LSG were found in operative time (153 vs. 93 min. p < 0.001), minor postoperative complications (21.5 % vs. 4.4 %, p = 0.005), blood transfusions (8.8 % vs. 1.7 %, p = 0.015), and length of hospital stay (4 vs. 3 days, p < 0.001). There were no differences regarding major complications and re-interventions. There was no surgery-related mortality. The percentage of excess weight loss up to 4 years was similar in both groups (66 ± 13.7 vs. 65 ± 14.9 %). Both techniques showed similar results in comorbidities improvement or resolution at 1 year. CONCLUSIONS: There is a similar short- and mid-term weight loss and 1-year comorbidity improvement or resolution between LRYGB and LSG, although minor complication rate is higher for LRYGB. Results of LSG as a single procedure need to be confirmed after a long-term follow-up.
  Obesity Surgery 11/2012; · 3.29 Impact Factor
• Article: Retroperitoneal inflammatory pseudotumor presenting as a pancreatic mass.

  Ignasi Poves, Sandra Alonso, Mireya Jimeno, Xavier Bessa, Fernando Burdío, Luís Grande
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  ABSTRACT: The inflammatory pseudotumor is a rare chronic inflammatory disease not considered as a real tumor but with a similar locally aggressive behavior. Although usually located in the lungs it may be found in other organs. We present the clinical case of a 66-year-old woman diagnosed with inflammatory pseudotumor after undergoing an exploratory laparotomy due to a large non resectable abdominal mass. Preoperative abdominal CT revealed a large solid polylobulated mass involving the pancreas, duodenum, hepatic hilum and superior mesenteric artery. Percutaneous fine needle aspiration and tru-cut biopsies ruled out lymphoma but did not achieve a definitive diagnosis. CD68 antibody positivity of the surgical biopsy specimen confirmed the histiocytary origin. Ki67 antibody expression was 10%. The final diagnosis was inflammatory pseudotumor rather than malignant fibrohistiocytoma based on the features and the severity of the inflammatory component. Chemotherapy was ineffective and the patient died 25 months later because of local progression and infection of the tumoral necrotic tissue. Although inflammatory pseudotumor is not considered to be a real tumor, its aggressive local growth is similar to that of malignant soft tissue sarcomas. The only curative option is the complete surgical resection, albeit frequent recurrence.
  JOP: Journal of the pancreas 01/2012; 13(3):308-11.
• Article: Activation of the BMP4 pathway and early expression of CDX2 characterize non-specialized columnar metaplasia in a human model of Barrett's esophagus.

  Daniel Castillo, Sonia Puig, Mar Iglesias, Agustín Seoane, Carme de Bolós, Vicente Munitiz, Pascual Parrilla, Laura Comerma, Richard Poulsom, Kausilia K Krishnadath, Luís Grande, Manuel Pera
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  ABSTRACT: A human model of gastroesophageal reflux disease was used to examine the contribution of a non-specialized columnar type of metaplasia (NSCM) and key molecular events (BMP4 and CDX2) in the development of Barrett's esophagus. Biopsies of the remnant esophagus from 18 patients undergoing esophagectomy with gastric preservation were taken at 6-36-month intervals postoperatively and examined for activation of the BMP pathway (BMP4/P-Smad 1/5/8) and CDX2 and CDX1 expression by imunohistochemistry, quantitative real-time PCR, Western blot, and in situ hybridization. A short segment (mean 15.6 mm) of NSCM was detected in 10 (56%) patients, with an increasing prevalence from 17% at 6 months to 62% at 36 months. Nuclear expression of P-Smad 1/5/8 in the squamous epithelium close to the anastomosis with strong expression in all epithelial cells of NSCM areas was found. Forty-eight (63%) biopsies with NSCM showed scattered nuclear expression of CDX2. Two cases showed isolated glands at 18, 24, and 36 months that fully expressed CDX2 and co-expressed CDX1. BMP4 mRNA and CDX2 mRNA levels were significantly greater in NSCM than in squamous epithelium. BMP4 activation in NSCM and early expression of CDX2 are involved in the columnar epithelial differentiation of Barrett's esophagus.
  Journal of Gastrointestinal Surgery 11/2011; 16(2):227-37; discussion 237. · 2.83 Impact Factor
• Article: [Quality of life of patients with cancer of the oesophagus and stomach].

  Dimitri Dorcaratto, Luís Grande, José M Ramón, Manuel Pera
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  ABSTRACT: The study of the health related quality of life in patients with digestive tract cancer, and particularly in those with tumours of the oesophagus and stomach, provides useful information for selecting the most suitable therapeutic option. It may also be used to predict the impact of the disease and its possible treatments on the physical, emotional and social condition of the patient. Various sensitive and reliable tools have been developed over the past decades that are capable of measuring the quality of life of patients; the use of questionnaires has made it easier to exchange information between the patient and the doctor. The pre- and post-operative variations in the quality of life in patients with oesophageal-gastric cancer are of prognostic value on the outcome of the disease. For all these reasons, the health related quality of life is currently considered, along with disease free survival and absence of recurrences, one of the most important parameters in order to assess the impact on the patients of a particular oncological treatment. The aim of this article is to review the role of the health related quality of life assessment, as well as the various tools which are available to measure it in patients with oesophageal-gastric cancer.
  Cirugía Española 09/2011; 89(10):635-44. · 0.87 Impact Factor